dicomPACS®DX-R Acquisition Software User Manual

User ManualdicomPACS®DX-R


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Contact

Head officeNeptunallee 7c18057 RostockGERMANY

Tel: +49 381 36600 500Fax: +49 381 36600 555

Email: [email protected]

International support hotline: +49 381 36600 800

Creation date: 04 / 05 / 2012

Software version: 2.3


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User Manual dicomPACS®DX-R

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Warnings and advisory symbols

To ensure the safety of patients, staff and other persons, any changes tothe software and hardware delivered by Oehm und Rehbein GmbH (ORTechnology) may only be made with prior written permission from ORTechnology.

Please read the respective manuals of the connected devices, such as ofthe X-ray generator, sensor/detector or scanner, before usingdicomPACS®DX-R.

The following symbols will be used throughout this manual:

DANGER

The „Danger“ icon advises of conditions or situations that ifnot heeded or avoided will cause serious malfunction to thesoftware. The functionality of the software can be destroyedin the case of incorrect use.

If unauthorised changes have been made to the deliveredsoftware and hardware components, the warranty by ORTechnology becomes void. OR Technology will not acceptany responsibility or liability for the correct functioning of theproduct in such a case.

CAUTION

The „Caution“ icon points out important information, that isrelevant for the correct functioning of the product.

NOTE

The „Note“ icon gives information that is generally importantto know, but does not affect the functioning of the software.

PRACTICAL HINT

The „Practical Hint“ is a recommendation on how theworkflow can be simplified within the software.

User Manual dicomPACS®DX-R

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Chapter 1. Introduction 9

1.1 Operating requirements............................................ 101.1.1. Monitor requirements............................................... 101.1.2. Software installation................................................. 111.2 Important software information................................ 121.2.1. Application area ....................................................... 131.2.2. Measuring................................................................ 131.2.3. Compatibility ............................................................ 141.2.4. Monitor quality ........................................................ 141.2.5. Image resolution ...................................................... 14

Chapter 2. Working with dicomPACS®DX-R 15

2.1 Programme start and login ....................................... 152.1.1. Virtual keyboard ....................................................... 162.2 Patient view.............................................................. 172.2.1. Create a new patient ................................................ 182.2.2. Query a DICOM worklist (optional)............................ 192.2.3. Create an emergency patient .................................... 192.2.4. Delete a patient ........................................................ 202.2.5. Search for a patient or an examination...................... 202.2.6. Worklist entries......................................................... 202.3 X-ray view ................................................................ 232.3.1. Plan.......................................................................... 232.3.2. Edit .......................................................................... 282.3.3. Image acquisition process ......................................... 302.3.3.1. DR system................................................................. 302.3.3.2. CR system................................................................. 312.3.4. Exposure .................................................................. 332.3.4.1. Sensitivity factor - S-value ......................................... 352.3.4.2. White point .............................................................. 392.3.4.3. Quality assessment of images ................................... 402.3.4.4. Black border / cropping............................................. 402.3.5. Retake / discard images ............................................ 422.3.6. Accept an image ...................................................... 432.3.7. Finish a study ........................................................... 432.3.8. Display images in the viewer ..................................... 452.3.9. Exposure status ........................................................ 452.4 Lists view.................................................................. 472.4.1. Extend a study.......................................................... 502.4.2. Send ........................................................................ 512.4.3. New study ................................................................ 522.4.4. More........................................................................ 522.5 Configuration of examinations and macros ............... 552.5.1. Change an examination ............................................ 572.5.1.1. Procedure codes ....................................................... 58


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2.5.1.2. Image processing...................................................... 592.5.1.3. Generator values....................................................... 612.5.2. Change the structure of exposures ............................ 632.5.2.1. Move examinations................................................... 652.5.3. Create a macro ......................................................... 65

Chapter 3. The dicomPACS®DX-R Viewer 67

3.1 The toolbar - general handling.................................. 683.1.1. Tool area annotations............................................... 713.1.1.1. Configuration dialogue of the annotations................ 863.1.2. Tool area turn / mirror .............................................. 943.1.3. Tool area grid ........................................................... 953.1.3.1. Configuration dialogue for grids ............................... 953.1.4. Tool area brightness ................................................. 993.1.4.1. Brightness tools ........................................................ 993.1.4.2. Configuration dialogue of the brightness tools........ 1003.1.5. Tool area image selection ....................................... 1023.1.5.1. Image selection tools .............................................. 1023.1.5.2. Configuration dialogue for the image selection tools 1033.1.6. Tool area magnifier / zoom..................................... 1043.1.6.1. Magnifier / zoom tools ........................................... 1053.1.6.2. Configuration dialogue of the magnifier/zoom tools 1083.1.7. Tool area management........................................... 1113.1.7.1. Management tools ................................................. 1113.1.7.2. Anonymize/customize DICOM data......................... 1343.1.7.3. Configuration dialogue of the management tools ... 1393.2 Extended tools........................................................ 1433.2.1. Tool area Filter / dynamic ........................................ 1433.2.1.1. Tools of filter/dynamic ............................................ 1443.2.1.2. Configuration dialogue of filter /dynamic ................ 1473.2.2. Stitching................................................................. 1503.3 The working area.................................................... 1543.3.1. Mouse button functions ......................................... 1543.3.2. Quick access menu ................................................. 1553.3.3. Full screen display................................................... 1563.4 The navigation bar.................................................. 1573.5 The information bar................................................ 158

Chapter 4. Appendix 159

4.1 Conformance statement ......................................... 1594.2 CE Certificate .......................................................... 1604.3 Quality Management .............................................. 1624.4 CMDCAS certificate................................................. 163

Chapter 5. Notes 164


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Chapter 1. Introduction

Thank you very much for deciding on dicomPACS®DX-R - our X-rayacquisition software for DR (flat panels) and CR systems.

The dicomPACS®DX-R software is an independent product for theacquisition, processing and optimization of X-ray images (raw images)provided by flat panel (DR) systems or CR systems. In principle, the brandof the particular DR or CR device makes no difference to the operation ofthe software. The open architecture of the software allows theintegration independent of the producer.

This user manual provides detailed information about the operation ofdicomPACS®DX-R and the use of the range of facilities included in thesoftware to make the processing and administration of your medical X-ray images as efficient as possible.

Quality management

The product development process is subject to a quality managementsystem in accordance with DIN EN ISO 13485:2003.

Safety instruction

To ensure the safety of patients, staff and other persons, any changes tothe software and hardware delivered by OR Technology may only beextended with prior written permission from OR Technology.

Liability

If unauthorised changes have been made to the delivered software andhardware components, the warranty by OR Technology becomes void.OR Technology will not accept any responsibility or liability for theaccurate functioning of the product in such a case.

Enjoy reading the manual as well as working with dicomPACS®DX-R.

OR Technology

Please read the complete manual carefully before starting touse dicomPACS®DX-R system. Our support team will beglad to help you, if you have any queries.


-10- 1.1 Operating requirements

1.1. Operating requirements

Table 1. Operating requirements

1.1.1. Monitor requirements

The acquisition software is primarily designed for viewing monitors tooverview the acquisition process and must thus only be used on colourmonitors.

A viewing monitor should satisfy the following requirements:

1. VGA and/ or DVI connection2. Resolution of at least 1,280 x 1,024 pixels3. TFT-colour from 17” with high contrast ratio (450:1)

Processor: Intel Core Duo / Core 2 Duo or comparable with AMD DualCore Processor

RAM: Minimum 2GByte RAM

Hard drives: Minimum 80GByte for software and for the archive

Hard drive C:\ (for installation) and D:\ (for acquired data,minimum capacity of 25GByte) is required

Network: Minimum 100MBit

Graphicscard/Monitor:

Colour screen with resolution of minimum 1,280 x 1,024pixel, using the true-colour mode

Resolution of 1,024 x 768 pixel is recommended forembedded systems

Operatingsystem:

Windows XP, Windows 7

The operating system for dicomPACS®DX-R should normallybe a Windows XP Professional. In some cases Windows 7 mayalready be used. Whereas dicomPACS®DX-R itself works onWindows 7 without restrictions, there can be restrictionsconcerning the flat panel. A minimum of 2 GB RAM isnecessary to ensure a smooth workflow

Flat panels: Please note the requirements for the different flat panels andgenerators, e.g. additional network cards or serial ports

CAUTION

dicomPACS®DX-R is not designed for b/w monitors!


1.1 Operating requirements -11-

4. High fidelity of grey tones and good luminance distribution5. Optional preset DICOM LUT

For diagnostic purposes, we recommend separate workstations, wherequalified, diagnostic monitors are available. The minimum requirementsfor monitors that are used for diagnosis are described in the countryrespective directives regarding diagnosis on monitors and medicalproducts laws. All monitors must conform to the requirements ofthe IEC 61223-2-5:1994 and pass the acceptance and display test.

The size of the screen depends on the type of images.

We recommend that a diagnostic monitor should satisfy the followingrequirements:

1. DVI connection (no VGA)2. Resolution of at least 1,280 x 1,024 pixels for embedded systems3. Special b/w monitors from 18,1“ TFT with high luminance and

contrast for embedded systems4. High fidelity of grey tones and optimal luminance distribution5. Preset DICOM LUT

1.1.2. Software installation

Please run the included setup „*_setup.exe”. The setup creates the latestversion of the dicomPACS®DX-R software on the C:\ drive of your PC.

After the installation, a dicomPACS®DX-R icon is displayed on thedesktop. dicomPACS®DX-R starts by double clicking on the icon. Thesoftware is started in the demo mode; a message will be displayed thatthe programme uses a temporary license. Please confirm this informationby clicking on „OK”; the installation may then be finalised and used. Thedemo license is only available for 20 days; within this time frame a validlicense has to be obtained. You may obtain a license either via a dongleor the request key issued by the license manager.

NOTE

A b/w monitor can only be used as an additional diagnosticmonitor, not for primary use!


-12- 1.2 Important software information

1.2. Important software information

The dicomPACS®DX-R software is an independent product for theacquisition, processing and optimisation of X-ray images (raw images)provided by flat panel (DR) systems or CR systems.

In general, such software is also called „console software” as it isinstalled on the so-called „console PC” of the imaging device.dicomPACS®DX-R carries out the image processing of the raw imagesprovided by the particular device and provides the radiographer / X-rayassistant with an optimum workflow for their work.

The large range of functions includes a professional image viewer and adetailed multimedia radiographic positioning guide to support thecorrect preparation of exposures. During the development of thesoftware, strong emphasis was placed on a smooth workflow to simplifyand shorten procedures and to eliminate potential sources of error.

The X-ray images provided by dicomPACS®DX-R are stored in adatabase and are made available to picture archiving andcommunication systems (PACS). The option of communicating withpatient management systems (HIS, RIS, etc.) to exchange patient data isalso integrated.

In short, dicomPACS®DX-R is a comprehensive, independent softwarefor the complete integration of DR/CR systems, X-ray generators, imageprocessing and patient management systems. It enables the simple andfast creation of professional X-ray images and further processing of theseimages in both human and veterinary medicine.


1.2 Important software information -13-

FIGURE 1. Functional principles of dicomPACS®DX-R

1.2.1. Application area

dicomPACS®DX-R is meant to be used by qualified medical personnelonly. All users must be qualified to create and diagnose radiologicalimage data.

dicomPACS®DX-R is not approved for the acquisition ofmammographic image data.

1.2.2. Measuring

In addition to acquiring and displaying images, the application alsoallows them to be measured.


-14- 1.2 Important software information

1.2.3. Compatibility

When processing dicomPACS®DX-R orders, the compatibility of hard-and software is ensured. During the installation this will be finallychecked.

1.2.4. Monitor quality

Medical X-ray images may only be examined with dicomPACS®DX-R onapproved diagnostic monitors. The relevant certification is ensuredaccording to IEC 61223-2-5:1994.

1.2.5. Image resolution

Images with a high resolution have to be scaled down to be displayed asa whole image on the screen (adjustment to screen size). After thisadjustment, not all of the image information available is displayed on thescreen. Please use monitors with the required high resolution and the100% display function of the dicomPACS®DX-R viewer.

CAUTION

Measurements can be taken of lines (in millimetres) andangles (in °, degrees). The length of a line can only be givenin millimetres if the DICOM image contains the referencescale of pixels to the resulting length.

CAUTION

In order to test the consistency of these parameters duringthe operation, the monitor consistency tests must beperformed at regular intervals. The regularity of these tests islaid down in the acceptance protocol. In general, a dailyvisual check must be performed. This check is described onpage 108. In particular, the 5% and 95% greyscale areasmust be clearly discernible.


2.1 Programme start and login -15-

Chapter 2.Working with dicomPACS®DX-R

First of all, start the dicomPACS®DX-R application by a double click onthe icon dicomPACS DX-R, which is located on the desktop or by usingthe „start menu -> programme -> dicomPACS -> dicomPACS DX-R“. Ifthe demo mode of the software starts, a message will be displayed thatthe programme uses a temporary license. Please confirm this message byclicking on „OK”.

2.1. Programme start and login

Once the programme has been started, the user will be asked to login.Depending on the login level, the programme components „supportmode” and/or „configuration” can be called up. The support mode isonly accessible for users having administration rights.

FIGURE 2. Login screen

The software dicomPACS®DX-R is divided into different screens whichare passed through successively. The first screen is the patient view, thesecond is the X-ray view and the last screen, which belongs to theworkflow, is the lists view. A further screen is the management view.


-16- 2.1 Programme start and login

2.1.1. Virtual keyboard

The entire interface is designed for touch screen operation, with theexception of special measuring functions. In this case the data cannot becaptured with the virtual keyboard. The virtual keyboard appears afteractivating an input field.

FIGURE 3. Virtual keyboard

FIGURE 4. Virtual keypad

NOTE

For the usual work with the software, the demo version doesnot require a special login. If you do not need to use thesupport mode or the configuration mode, please justconfirm the boxes „user name” and „password” by pressingthe ENTER key.


2.2 Patient view -17-

2.2. Patient view

After the login to dicomPACS®DX-R, the programme startsimmediately with the patient view. This is where patient dataand X-ray assignments are recorded. On the left hand side ofthe screen, all data of a patient is displayed or to be entered.

The right hand side of the screen shows the worklist. If the system hasbeen newly installed or if all patients have been dealt with, this list will beempty.

FIGURE 5. Patient screen

When using a touch screen, the patient data will be captured via thevirtual keyboard. The keyboard appears after activating an input field. Tostart a patient workflow, three options are available:

Logout and display of current user

Captures patients and work assignments

Delete jobs

Worklist

Search for X-ray assignments in the worklist

Area for entering / changing patient data


-18- 2.2 Patient view

FIGURE 6. Worklist

2.2.1. Create a new patient

A click on the „new“ button allows the user to enter data of anew patient in the input fields on the left hand side of thescreen. The input fields are optional fields. In the line of buttonsto denote the gender, it is also possible to select the pregnancy

status of the patient.

FIGURE 7. Create a new patient manually

The pregnancy status is set during the creation of a new patient.Theselection menu of setting the pregnancy status appears by clicking onthe pregnancy status button.

The recording of the pregnancy status can take place in the patient asview well as the X-ray view. It is possible to activate an automatic inquiryof the pregnancy status of females in a pre-defined age group in thesupport mode.

Search bar

Delete a worklist

1. Create a new patient manually

2. Query a worklist (RIS) 3. Create an emergency patient

Total number of worklist entries

Owner information

Patient information

Description of the study

Note field for additional patient information

Reference number for examination

Name of the requesting physician

Selection of the gender and pregnancy statusF - femaleFS - female spayedM - maleMC - male castratedN/A - not available



FIGURE 8. Pregnancy status

2.2.2. Query a DICOM worklist (optional)

After having clicked the „RIS” button, a DICOM worklist isqueried and the results are entered into the worklist. Theworklist has to be configured beforehand. Alterations or

additions may be made at any time by clicking on the data fields on theleft hand side of the screen.

2.2.3. Create an emergency patient

It is always possible to interrupt an ongoingexamination if necessary, for instance due to anemergency. Simply switch to the patient view and

press the „emergency“ button. This function is useful if there is no dataavailable on a patient or an examination must be carried out very quickly.After clicking on the emergency button, the system automatically createsa new patient called „emergency”. The patient ID consists of the dateand the time of the record (#-<timestamp>), so that the correct patient

Select the pregnancy status

NOTE

The pregnancy status may not be set to „not queried“ as afinal status. In this case it would pop up again, e.g. after theprocessing of the image when switching back to the X-raytab. Please select one of the first three options.

NOTE

When clicking the RIS button in the demonstration mode,some virtual patients are inserted into the worklist already.



data can be entered at a later stage by reopening the study (seepage 50). The correct patient data can be insert in the patient view andthe study can be closed and send to the archive again.

2.2.4. Delete a patient

This button allows to delete a selected patient from theworklist.

2.2.5. Search for a patient or an examination

The search bar is located above the patient entries. By using this bar it ispossible to search for data across several fields. The software alwayssearches through the fields „last name“ and „study description“simultaneously. Patients in the worklist that are marked red areinterrupted patients.

FIGURE 9. Search bar

Example:If the search word is only the letter „A“, the software lists all entries inthe fields „owner name“, „animal name”, „accession number“ and/or„study description” where the letter „A” is included.

2.2.6. Worklist entries

Each worklist entry has a status and will be displayed in a certain colourin accordance with its status.

NOTE

The option „delete“ is only available if there are no images orplanned examinations associated with this patient.Otherwise the button will be disabled by the system.

Entry box for the search word in the patient/worklist

Reset button, deletes the search string



FIGURE 10. Worklist entries

Interrupted worklist entries are displayed in red. They are always locatedat the top of the list and are sorted by time. An interrupted worklist entryis a special feature. It means that images for a patient have been plannedor taken, but further processing has not taken place. It can be necessaryto interrupt a patient if a sequence of examinations requires repeatedbreaks or to deal with an emergency. New worklist entries, without anyplanned examinations, are displayed in grey, the selected entry isdisplayed in blue. New worklist entries are located below the interruptedworklist entries and are also sorted by time.

Interrupted patient

Entry without any examination planned or carried out

Selected enty without any examination carried out



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2.3 X-ray view -23-

2.3. X-ray view

In the X-ray view it is possible to plan, edit and take exposures.

FIGURE 11. Selection fields in the X-ray view

2.3.1. Plan

After selecting or creating a patient, there are two ways toswitch to the X-ray view. The first option is to double click onthe patient. The second is to select the patient and to clickon the X-ray icon.

FIGURE 12. Planning mode of the X-ray view

Logout user, patient name, DOB and study description

This area lists the jobs for the single exposures of this examination

Switch between the organ structures for different animals (cat/dog/horse/mammals/dental examinations of small mammals if activated)

Icon for displaying the defined macros for the entire organ structures

Set the pregnancy status of the patient


-24- 2.3 X-ray view

The first illustration for the planning of X-ray exposures is displayed onthe left hand side. The complete selection of organ structures is shownunderneath. Click on the respective icon (of different animal species [anddental examinations of small mammals if enabled by a technician]) toactivate the corresponding organ structure.Each organ structure is divided into different sections (animal parts).When clicking on an animal part, e.g. the skull, all available standardexaminations of the selected animal part will be shown. A newexamination can be added to the worklist on the right hand side with aclick on the required examination.The information about the pregnancy status has to be entered via theicon in the upper centre. Different statuses can be selected.

NOTE

The macro icon with the „+“ sign is displayed at the uppercentre of the illustration. This is where several macro buttonsfor recurring examination procedures can be configured.Such procedures may for instance be screeningexaminations, examinations of organs in several planes oreven display checks. Macros may also be stored directly in aanimal part section, e.g. „skull”.


2.3 X-ray view -25-

FIGURE 13. Planning mode of the X-ray view

Selected examinations incl. suggestions on the generator settings- A click on the image displays a radiographic positioning guide for this examination

- The X-ray symbol shows that this exposure is still outstanding- If no ACE is selected, kVp and mAs values show the recommended

values- If AEC is selected the mAs value represents the back up mAs. After the exposure, the value changes to the applied mAs

- DAP (Dose Area Product) can be inserted manually or taken over automatically (depending on the configuration)

Examination of a selected animal part

Return to the organ structure of the animal species required

NOTE

If the detector has been configured as a demo panel, anapostrophe behind the examination name indicates that ademo image will be loaded if the X-ray shot is simulated.


-26- 2.3 X-ray view

FIGURE 14. Planned examination

PRACTICAL HINT

The whole list of examinations can be customised manuallyby using the configuration mode:

• creating new examinations / macros

• changing the order of examinations / macros

• hiding examinations / macros

• changing the colour of examinations

• changing / inserting procedure codes for examinations

• changing the image processing of examinations

NOTE

The yellow font on some of the buttons indicates frequentlyused basic settings.

For some of the examinations, no demo images are available.In this case, a selection box is displayed when the exposure istriggered from which a raw data demo image can beselected. This allows the user to import his own raw dataimages into the software and to run them through thedicomPACS®DX-R image processing algorithm. To adaptthe image processing or to create a completely new imageprocessing, administrator rights are required.

Suggested values

Edits the examination

Opens the radiographic positioning guide

Dose Area Product

Indicates the number of rejected exposures

Indicates, that this exposure is outstanding

Post exposure values


2.3 X-ray view -27-

New plannings can be added inbetween already scheduled plannings.The desired position is simply to be selected and a new planning can bescheduled. The new examination is always inserted below the selected,existing planning.

The planned examinations in the worklist include suggested generatorvalues, which depend on whether an AEC is activated.

In addition, the name of the selected examination is inserted. The X-raysymbol indicates that the exposure is still outstanding. The kVp and mAs values are the recommended values for the plannedexamination.

A further window will be opened for the radiographic positioning guide,with more detailed information on taking the exposure. The radiographicpositioning guide consists of example X-ray images, text, videos andimages for the exact positioning of the patient. The preview and the video of each examination may be customisedindividually. For the setup, please view page 62.

NOTE

The insertation of new plannings is not possible before oneor between two already exposures that have already beentaken.

PRACTICAL HINT

All generator values for each examination can be customisedmanually either from a service engineer or a user withadministration rights using the configuration mode. Seesection Assignment of generator values to examinations inthe support mode of the technical manual for furtherinformation on the configuration.

NOTE

When using the AEC measuring chamber, the mAs value ismeant as a backup mAs value.


-28- 2.3 X-ray view

FIGURE 15. Radiographic positioning guide

After the exposure, the data provided by the Dose Area Product meter isentered automatically into the „DAP” field or can be entered manually.

2.3.2. Edit

If a wrong examination has been added to the worklist, it can be deleted.Therefore, switch to the edit tab and press the „bin button“ next to thecorresponding examination. Furthermore, it is possible to exchange an examination by selecting anew examination on the left side or to review carried out exposures (clickthrough the preview image) by using the „edit“ tab.

NOTE

To add other projections from different body parts to theexamination list, just click on the button with the respectiveorgan structure. The overview will be displayed immediatelyand the new projection can be selected. The position of thenew inserted examination can be edited by your technician.


2.3 X-ray view -29-

FIGURE 16. Edit a planned exposure

By pressing the „Edit examination data“ button, an edit mask opens andit is possible to edit the entire examination information.

FIGURE 17. Edit examination data

By using the edit mask, additional image information can be inserted,e.g.:

• exposure with plaster or • exposure with radiopaque material

Edit examination dataBin button to delete a planned examination

NOTE

The image comment is stored inside the DICOM image.

CAUTION

When kVp and mAs values are changed via the edit mask,they will not be synchronised with the generator. Thesevalues are only for documentation purposes.


-30- 2.3 X-ray view

When the planning procedure has been finished, switch to the exposuretab to start the exposure.

2.3.3. Image acquisition process

There are two types of image acquisition processes to arrive at anexposure, either to use CR systems or flat panel (DR) systems.

FIGURE 18. Image acquisition options

The actual X-ray exposure is prepared by clicking on the button„exposure”. The generator panel is an optional GUI component. Allvalues can also be adjusted and sent by an external X-ray generatorconsole. In that case, the generator GUI component must bedeactivated.

2.3.3.1. DR system

The following screen is displayed when starting the acquisition process ofthe DR system, whereby more than one detector can be connected.

NOTE

When an image has been taken, it is possible to switch backto the edit mode to change the type of examination. Tochange the image processing of this exposure, first choosethe according body part on the left hand side of the screenand afterwards the required examination. The image will bereprocessed and the examination name will be replaced.


2.3 X-ray view -31-

FIGURE 19. X-ray view without generator panel with a DR system

All parameters will be configured and sent automatically to thegenerator. When all data has been sent and verified, the flat panel isready and the status LED is green, the radiographer triggers the exposureat the actual X-ray system.

2.3.3.2. CR system

The following screen is displayed when starting the scanning process of aCR system.

Status indicatorGreen : Detector is readyYellow: Data transmissionRed : Error

Detector name/status messages

DANGER

The values shown in the generator panel (kVp, mAs, mA,etc.) are only recommendations (guidelines) and mustalways be verified before an X-ray is taken. These values canbe adjusted in the value table for the particular generator.For questions please refer to your retail consultant forgenerators.If no direct generator panel has been installed, it is urgentlyrecommended to add the values set manually for eachexposure in the generator panel as well. This has theadvantage that the values actually applied are storedtogether with the corresponding image (in the DICOMheader) and can be recorded in the X-ray log. This isimportant for the correct documentation of each individualexposure.

NOTE

If no generator is connected, the generator settings arenecessary for documentation purposes.

CAUTION

Each connected detector must be calibrated by anauthorised service engineer.


-32- 2.3 X-ray view

FIGURE 20. X-ray view with a CR system (no integrated generator panel installed)

When using the integrated generator panel, all standard values andsettings (kVp, mAs, focus, etc.) will be displayed as recommendations.They can be changed in the support mode.

Status indicatorGreen : Scanner is readyYellow: Data transmissionRed : Error

Scanner name/status messages

DANGER

The values shown in the generator panel (kVp, mAs, mA,etc.) are only recommendations (guidelines) and mustalways be verified before an X-ray is taken. These values canbe adjusted in the value table for the particular generator.For questions please refer to your retail consultant forgenerators.If no generator values are sent to the generatorautomatically, it is urgently recommended to add the valuesset manually for each exposure at the generator console aswell. This has the advantage that the values actually appliedare stored together with the corresponding image (in theDICOM header) and can be recorded in the X-ray log. This isimportant for the correct documentation of each individualexposure.

NOTE

Generator values must be correctly indicated fordocumentation purposes, even when the generator is notconnected and the values are manually changed at thegenerator console.


2.3 X-ray view -33-

2.3.4. Exposure

FIGURE 21. Generator panel

The generator panel is displayed at the start of the exposure acquiringprocesses by cling on the button exposure. In case more than one work station has been set up in the supportmode, they appear in the upper area of the generator panel.

Apart from the values for kVp and mAs, that are passed on to thegenerator, it is possible to adjust the recommended values for the weightof the patient or the thickness of the individual body part. The requiredvalues of kVp and mAs will be adjusted automatically. Furthermore, the density points can be adjusted. The required values ofkVp and mAs are again adjusted automatically.The information about the pregnancy status has to be entered via theicon in the upper centre above the generator panel. Different statusescan be selected.

Grid on/off

Adjusts the thickness of the body part

Focus small/large

Selects the measuring chamber

Adjusts density points

Restores the recommended settings

Settings of the generator values

Switches between different work places

Status indicatorGreen : System is readyYellow: Data transmissionRed : Error

Detector name/status messages

Technical details of the generator and geometry (X-ray beam: FFD, filter)

NOTE

If the grid is not set correctly, a flashing warningappears and the generator is blocked.


-34- 2.3 X-ray view

As soon as the X-ray image has been taken, it is optimised in accordancewith the image processing algorithm stored for the examination and isdisplayed immediately. A toolbar is then displayed beneath the preview.

FIGURE 22. Preview image

This is where different options for displaying the image (e.g. fit image,rotate image, etc.) are available.

FIGURE 23. Toolbar

The following tools are included in the toolbar:

Displays the image pixel per pixel (full resolution)

Dose indicator:Shows the approximate equivalent film speed

Toolbar

Fully processed preview of the new X-ray image

Fitting

White point

Open Viewer

100%

Quality assessment

Discard / retake

Accept image

Zoom - Brightness -

Reset to originalRotate left

Zoom + Brightness +

Rotate right Blackborder / crop


2.3 X-ray view -35-

Table 2. Tools for preview image

2.3.4.1. Sensitivity factor - S-value

Dose index, S-value, Dose indicator

In the following you will find an explanation on the image processingwith regards to the dose index.

Shows the complete image

Enlarges the image

Reduces the image

Rotates the image to the right by 90°

Rotates the image to the left by 90°

Increases the perceived brightness (gamma curve)

Reduces the perceived brightness (gamma curve)

Draws or adapts the black border around the image

Restores the original condition of the image

Rejects a bad exposure

Accepts / reopens an exposure

Opens the study using the included viewing application(diagnostic mode)

Allows the quality assessment of new images

Re-determines the Region Of Interest (ROI)


-36- 2.3 X-ray view

Basics

With digital radiography it is not possible to determine the actual imagereceptor dose exclusively by the brightness impression of the final image,unlike the creation of analogue images that represents this value.

Incorrect exposures can be compensated by the image processing in awide range (automatic signal normalisation), so that there is always aconstant brightness and contrast effect. There is no direct relationshipbetween the image receptor dose (dose required), and the opticaldensity of the image!

Following are examples of varying radiation doses that were taken with aVarian „PaxScan 4343R“ (GadOx):

FIGURE 24. Image receptor dose comparison

With digital radiography underexposed images have enhanced noise andless detail. Overexposed images increase the radiation of the patient andpartially the staff.

54 KVp and 0.60 mAs

54 KVp and 1.80 mAs

Image preview

54 KVp and 0.15 mAs

54 KVp and 1.05 mAs


2.3 X-ray view -37-

In most countries it is regulated that the manufacturer of digitalradiography systems must define a dose indicator (dose index), whichindicates the sensitivity of the image receiving system. The dose indicatorgives the user of the system the ability to draw conclusions on the doseused for an image.

In Germany, this is regulated in DIN 6868-58. It says regarding thedefinition of the dose indicator:

It is „a manufacturer-specific value of the digital image receiving systemspecified for each image that correlates under the same recordingconditions with the image receptor dose”.

dicomPACS®DX-R uses a numerical value as a dose indicator that isoriented towards the S-value (Speed Class) of the sensitivity classes offilm-sheet systems.

Table 3. Speed Classes

When X-raying analogue with film-screen combinations the respectivedose (see table) generates an optical density (OD) of 1 above the X-rayfog. Thus, for example for a film with the sensitivity SC = 400, a dose of2.5 Gy is required to generate an optical density of 1 (medium gray).

In practice

The dose index (S-value) is calculated at the bottom right corner of theimage (blue font) after the image acquisition with dicomPACS®DX-R.

Speed Class (SC) Dose required Gy Description

100 10.0 High definition

200 5.0 Universal film

400 2.5 High gain

800 1.25 Highest gain


-38- 2.3 X-ray view

FIGURE 25. S-value

If the displayed image gives the desired brightness impression, you candraw conclusions via the displayed S-value on the average imagereceptor dose.

If the image is displayed too dark or too light, the displayed S-value isincorrect too.

If you set the white point again, it will change the impression ofluminosity and thus the indicated dose indicator.

The relationship between S-value and radiation dose is inverselyproportional.

High S-value -> small dose (underexposure)

Small S-value -> high dose (overexposure)

A high S-value means a small image receptor dose. S-values above 1000indicate a strong underexposure. S-values below 50 indicate anoverexposure.

Consider the following example:

For the X-ray of a knee, a dose of about 5 Gy is required. The expectedS-value is approximately 200.

After the exposure an S-value of 630 is indicated.

Display of the S-value


2.3 X-ray view -39-

This means that the image was underexposed by the factor of 3.

In order to correct this, either the product of mA*s has to be increases bythe factor 3, or the dose has to be increased by the factor 3 with the helpof the buttons for the exposure points.

In the human field, there are guideline values at which the radiationexposure can be read according to the body regions.

Typical sensitivity classes are S = 200 for extremities, S = 400 for thetorso and S = 400-800 for children.

2.3.4.2. White point

This function allows the user to re-determine the Region OfInterest (ROI) for the image processing filters if the X-ray imagedoes not meet the expectations after it was taken. Click on thisfunction and then simply place the special rectangular cursor on

the lightest area of the bone structure. The currently used image regionis then highlighted with a red frame and the X-ray image is automaticallyre-configured.

FIGURE 26. White point

NOTE!

The displayed S-value is only an indicative guideline and mayshow deviations of the recommended image receptor dose.

Marked ROI


-40- 2.3 X-ray view

2.3.4.3. Quality assessment of images

The visual impression of the images can be evaluated as „good“,„moderate“, „poor“ and „not ratable“. The quality assessmentresults are analysed by a dicomPACS®DX-R dealer. If necessary,

the processing for certain exposures can also be adapted by the dealer.

FIGURE 27. Quality assessment for images

2.3.4.4. Black border / cropping

The cropping function is used in conjunction with the functionblack border and offers the possibility to crop collimated areasaround an image automatically when finishing a study. A drawnblack border is a precondition for this function.

FIGURE 28. Black border with normal edit helper annotations in the preview image

Evaluation of the image quality as:

Good

Moderate

Poor

Not ratable

Changes the size of the black border

Rotates the black border by guide arrows

Confirms the drawn black border

Moves the black border by guide arrows


2.3 X-ray view -41-

FIGURE 29. Black border with small edit helper annotations in the preview image

FIGURE 30. Results of the black border and cropping

The black border can be positioned with the red directional arrows.When pressing the button with the crossed out black border, the drawnblack border will be deleted and it can be re-drawn. Once the lines of the black border function are coloured blue, the blackmask cannot be adjusted.If the button with the scissors is chosen, the image will be cropped alongthe dashed rectangle.

Crops the exposure

Resets the black border

Result of black border Result of cropping

CAUTION

Before the cropping function can be used, it is necessary toactivate the tool in the support mode.


-42- 2.3 X-ray view

If a study with a drawn black border is finished, the croppingfunctionality can also be applied automatically in case it is set up in thesupport mode.

2.3.5. Retake / discard images

If an image does not meet the quality criteria because, forinstance, the patient moved or because the collimation of theX-ray device was incorrect, this exposure can be rejected.

FIGURE 31. Discarded image

For legal reasons it is not possible to delete rejected images. Thus, apreviously rejected image can be reactivated and used as the currentimage of that examination as long as this image has not been accepted.To reactivate the image simply click on the symbol „restore”.

NOTE

The system automatically reverts to the exposure mode andindicates in the examination list that this image has beenrejected. It also shows how many images of this examinationhave been rejected.

One image of this study has been rejected

The acceptance of all images concludes the study which is sent to the configured DICOM recipient

Rejected image with the „restore“ symbol


2.3 X-ray view -43-

2.3.6. Accept an image

By clicking on the checkmark, the currently visible image isaccepted. It is sent to the configured DICOM recipient (e.g.PACS) and is thus used as the „original image” created by thesystem.

2.3.7. Finish a study

By clicking on the button with the green checkmark and the label „finishstudy“, all images of the current patient are accepted and will be sent tothe recipient.There are a number of special cases to be considered:

• study with taken but not accepted exposures• study with both planned and taken exposures• studies without DAP values (if configured)

When trying to finish such a study, a pop-up window opens.

NOTE

All exposures are stored on the hard drive, independent ofwhether they have been rejected or not.

NOTE

The original image cannot be altered. It can, of course, beloaded into the viewer and subjected to additional imageprocessing. The changes made in the viewer, however, donot apply to the original image. They are stored in additionto the original image. If the image is loaded again from thedatabase at a later stage, the stored changes are simplyapplied to it.


-44- 2.3 X-ray view

FIGURE 32. Dialogue for exposures not yet taken

Usually it is necessary that each exposure contains a DAP (Dose AreaProduct) value, which can be configured by the dicomPACS®DX-Rsoftware. Usually, a pop-up window opens, when trying to finish anexposure or a study without DAP values.

FIGURE 33. Dialogue for DAP values

If a DAP value is not known, it is possible to finish the study by choosingthe option „Accept without dose value“. However, this option is notadvisable.

All taken exposures will be accepted; planned exposures will be deleted from the study

All taken exposures will be accepted; planned exposures will be kept in the study

CAUTION

The option for accepting exposures with or without dosevalues has to be configured, therefore refer to your softwaredealer.


2.3 X-ray view -45-

2.3.8. Display images in the viewer

dicomPACS®DX-R has an integrated professionalviewer. This viewer provides extensive imageprocessing options, such as inserting annotations,

measurements, printing, exporting of images and many more. Thefollowing chapter includes a detailed description of the viewer.

2.3.9. Exposure status

An icon next to each exposure shows its status, e.g. planned, taken orfinished.

FIGURE 34. Exposure icons

Finished exposure

Exposure has not been taken yet

Exposure has been taken, but not yet accepted


-46- 2.3 X-ray view

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2.4 Lists view -47-

2.4. Lists view

The lists view displays all studies of all patients. Finishedstudies are shown as well as unfinished studies.A detailed study status, including storage commitment - aquery whether data has been stored safely - give precise

information about the status of the individual studies.

In the lists view there are the options to search for studies using differentcriteria in the search bar, to load them into the PACS Viewer, to sent orprint them or to create a patient CD. In addition, incomplete studies canbe finished or a completed study can be re-opened (via the option toextend the study itself or to create a new study for the patient). Byclicking the „More“ button, currently selected studies can be deleted.The rejected images as well as the recycle bin can yet be displayedseparately.

NOTE

Storage Commitment must first be activated by a technicianin the Support mode to specify the appropriate archive.

When Storage Commitment is subsequently disabled, thenall images in which Storage Commitment was enabled,remain visible, including the detailed status.

PRACTICAL HINT

When an examination is highlighted, the screen can beswitched straight to the patient or X-ray view. This is wherepatient data can be changed or added, additional exposurescan be planned and new, not yet accepted images, can bealtered.


-48- 2.4 Lists view

FIGURE 35. Lists view - with active storage commitment

The lists view has three different display options:•not yet finished (displays all incomplete studies)•date or date-range when the image was taken (displays all studiesof a specific date or within a specified period of time when theimage was taken)

•all (displays all studies whether they are completed or not)

FIGURE 36. Time frame selection

Detailed display of the study status by clicking on „i“

Creates a new study for the selected patient

Accepts all images of the patient (the button is active when all exposures of a study have been

Search bar for search words, e.g. patient ID, name, study description, examination description of series, etc.

Prints the selected study

Creates a patient CD of the selected patient

Selection of the studies to be displayed

Sends images to an archive or a DICOM recipient

Shows images of a selected study in internal viewer

Studies with different status

Allows to move studies in the recycle bin, to open it and to get an overview of the rejected images

Select the time frame


2.4 Lists view -49-

FIGURE 37. Date range

If both elements of the date range search contain a date, all instanceswhich lie between those dates, will be displayed. If only the first elementcontains a date, only studies with an image made on that specific daywill be displayed. If the first element or both are empty, all images will bedisplayed. To select a date just enter a date in your respective date formatand confirm by pressing Enter or clicking on the button right to the textto open a calendar field.

Detailed status information can be displayed by clicking on the„i“nformation button within the study list.

The information corresponds to the following status including anindication of the number of associated images, for which the statusapplies. If no Storage Commitment is activated in the support mode, there aretwo different colour displays in the study list, each displaying the statusof the study:

•Red - the study is still in progress•Green - The study is completed

Start date

End date

NOTE

The date displayed is the date when the last image wastaken, not when the study was created.


-50- 2.4 Lists view

Various symbols of the study list entries without storage commitmentrepresent different status of the studies:

FIGURE 38. Status symbols without storage commitment

If Storage Commitment is activated for at least one archive, the studymay take three different states, which are also shown by differentcolouring in the study list entries:

•Red - the study is still in progress; it is not yet sent to the archive•Orange - the storage of the study in the archive is requested, butnot yet saved (request storage) or the storage of the study in thearchive is executed but not yet confirmed (not yet committed)

•Green - the storage of the study in the archive is confirmedVarious symbols of the study list entries with Storage Commitmentrepresent different status of the studies:

FIGURE 39. Status symbols with storage commitment

2.4.1. Extend a study

To extend a finished study, select the study from the lists view and choosethe X-ray view. A dialogue box opens with the option to extend a studyor to create a new study for the same patient in case the study is olderthan eight hours.

All exposures were accepted

Study includes exposures that we taken but have not yet been accepted

Not all planned exposures have been shot

No exposures were excepted

Not all planned exposures have been shot

No exposures were sent to PACS

All/several were sent PACS

All/several exposures have been archived by PACS

No exposures have been archived by PACS


2.4 Lists view -51-

FIGURE 40. Dialogue box to extend a study

When the option „Extend the study“ is chosen, the screenswitches immediately to the X-ray view and all taken exposuresare visible. Already accepted images can be reopened and re-sent to the archive by selecting the reopen image button. This

can be used e.g. when no position marker has been included whentaking the exposure and the user wishes to insert it afterwards.

FIGURE 41. Reopening of images

2.4.2. Send

After a click on the send button, the teleradiologydialogue appears. The recipient can be selected andthe study will be sent to the archive and other DICOM

recipients by confirming the selection. Additionally, the image quality canbe selected and thus the size of the data transfer.


-52- 2.4 Lists view

FIGURE 42. Send dialogue

2.4.3. New study

To create a new study of an existing patient, use theoption „New study for patient“. Please note that atfirst the patient has to be selected for whom a new

study should be created. The screen then switches automatically to the X-ray view and the new examinations can be planned. The applicationcreates a new patient with the same patient information only withoutany old planned or taken exposures and study descriptions.

2.4.4. More

More functions can be accessed by clicking on the button„More“.

There you have the option to choose between the following threefunctions:

Move Into Recycle Bin - deletes the currentlyselected study from the lists view, i.e. the studywill not be completely deleted from the

database, but it and all associated data will be assigned a special statusin the database, with which it is no longer available in the lists view.

Selects the set of images for sending

Selects the recipient

Selects the image quality

NOTE

This feature is only available for initially completed (greenmarked) studies.


2.4 Lists view -53-

Show Rejected Images - opens a list in which allrejected exposures are listed that have been

rejected during an examination. It is possible that exposures from acertain time frame are displayed and the overview can be exported asHTML or CSV.

FIGURE 43. Rejected Exposure Overview

Open Recycle Bin - displays all studies that weredeleted from the lists view. Single studies within

the recycle bin can be searched for by using the search bar. Furthermore,it is possible to restore studies by clicking on the restore symbol, which islocated in front of each study listing, to send them again to the lists view.Emptying the recycle bin may only be executed by the administrator orsupport technician with administrator rights. This results in a physicaldeletion from the local hard disk. All definitively deleted items are loggedin a separate file along with the information of the user who has emptiedthe bin. The studies that have been sent to the created archive willhowever remain.

Selection of the time frame in which the exposure was shot

Rejected exposures, sorted by exposure date

Export of the overview as HTML or CSV (suitable for the import in MS Excel)


-54- 2.4 Lists view

FIGURE 44. Recycle Bin

To avoid the accidental empty of the recycle bin, the daily password isrequested. Only after the successful entry of the password the recycle bincan be emptied.

FIGURE 45. Password of the day

Selection of the time frame Deleted study, sorted by exposure date

Empty Recycle Bin, can only be executed by a user with administration rights

Search bar

Restoring of studies


2.5 Configuration of examinations and macros -55-

2.5. Configuration of examinations and macros

To configure examinations and macros, switch to the configurationmode by clicking on the management view and then on the button„configuration“.

FIGURE 45. Start screen

The configuration mode is displayed immediately. It facilitates theadjustment or extension of organ structures provided by themanufacturer as well as the creation of macros for recurring examinationsequences.


-56- 2.5 Configuration of examinations and macros

Five options are available:•show current examinations•create new / copy examinations•delete newly added examinations•move examinations•remove or hide an examination from the organ tree

FIGURE 46. Configuration of macros / examinations

To alter an organ structure, first click on the required organ structure(small mammals/dog/cat/horse/dental examination of small mammals ifenabled by a technician)and then on the desired animal part. If a newmacro should apply to all body parts of the selected organ structure,click on the appropriate icon.After selecting the required body part, all available examinations aredisplayed. The right-hand side of the screen shows the existing macroswhich may be altered on the left-hand side of the screen. It is alsopossible to add new macros/examinations for the selected animal partnext to the already existing macros/examinations on the right-hand sideof the screen.

Macros for recurring examination processes can be stored here

1. Selection of the organ structure to be adapted (small mammals/ dog /cat/ horse and dental examinations of small mammals if enabled by a technician)2. Selection of the body part in which alterations are to be made



FIGURE 47. Configuration of macro / examinations

For each examination, the beam paths•PA (posterior-anterior) •AP (anterior-posterior)•DV (dorso-ventral and dorso-volar)•VD (ventral-dorso and volo-dorso)

and the orientation may be defined.

2.5.1. Change an examination

To change the name of an examination, click into the respective field andtype in the new name.

Existing examinations of the selected animal part

Change font colour

Reset to default font colour

Name of the examination can be changed

Option to capture new examinations or macros within this animal part

Selects the projection and orientation

NOTE

By entering a semicolon (;), a line break is inserted in thename of the examination. The text after the semicolon startsin a new line with a smaller font. It is also possible to enterseveral semicolons.



FIGURE 48. Change the name of an examination

Additionally, it is possible to change the colour of the font by choosingthe button „Choose colour“, as well as to restore the changed colour tobe a default setting by pressing the button „Sets the default colour“.

2.5.1.1. Procedure codes

Procedure codes are numbers or alphanumeric codes used to identifyspecific examinations taken by medical professionals. dicomPACS®DX-Roffers the possibility to work with different procedure codes. Theprocedure code of dicomPACS®DX-R is a proprietary OR Technologysolution.

FIGURE 49. Procedure codes

If dicomPACS®DX-R receives a worklist entry that includes a configuredprocedure code, the appropriate examination will automatically beplanned for the patient.

Examination name over two lines

Semicolon in the examination name for a line break

Enter the codes from different source

Examination with more than one procedure code



When a study is finished, the corresponding procedure code will be sentback to the patient management system.

2.5.1.2. Image processing

When an examination is configured, it is necessary to configure thecorrect image processing. To configure the image processing, select theaccording tabs in the configuration mode in the management view. Thetype of image processing can be selected and configured according tothe users‘ needs. It offers e.g. the option to configure an automatic flipor rotation of the images of an examination.

FIGURE 50. Image orientation

For security purposes the information that an image has been flipped isburned into the image on the lower right end of the image when it isaccepted; it can be found on the left in any other translated languages iflocalised. An icon that indicates that the image is flipped is also shown atthe upper centre of the image.

NOTE

It is possible that one examination has more than oneprocedure code from one modality. In addition, it is alsopossible that one procedure code includes more than oneexamination.

Tab Image orientation

Select rotate or mirror

Select the image processing parameters



FIGURE 51. Flipped image with icon and burned in information

Apart from the image orientation, the user may also configure the blackborder and burn in of IDs.

Burned in information - flipped image

Icon - flipped image

Tab Black border & burn in IDs

Activate/deactivate automatic black border for this examination

Activate/ deactivate burn in of study information



FIGURE 52. Black border and burn in of IDs

It is possible to burn in ID data of •the physician•the patient•the date and time and•the study description

all in once in an image. In the configuration mode you have the optionof either burning in the ID data for all images or you can select the burn-in for individual images in the toolbox annotations in the viewer, seepage 71.

2.5.1.3. Generator values

The tab „Generator values“ allows the adjustment of the suggestedgenerator values. The suggested X-ray values of an exposure depend onwhether AEC is activated. On the one hand it is possible to adopt the generator values fromexisting examinations simply by choosing the required one from the listwhen clicking on the arrow on the right. On the other hand it is possibleto adjust the values manually with a click in the respective field.

FIGURE 53. Generator values

Adopt generator values from an existing examination

Change the values manually



All generator values are stored in examination groups and allexaminations are assigned to these groups.

Example:Skull DV and skull VD are in the same examination group. If the userwants to have different values for these examinations, first of all theexaminations have to be listed into different groups.To list a new examination group with new generator values, it isnecessary to click on the arrow on the right next to the examinationgroup and then on the empty entry at the beginning of the list entries. In the veterinary version of the software it is also possible to adjust theweight steps in the tab „Generator values“ for the chosen examination(in the support mode it is possible to adjust the values for all examinationtypes). If you click on the edit button the following dialogue appears,where it is possible to adjust the kVp and mAs values according to theselected weight group.

FIGURE 54. Edit weight steps

NOTE

Please note, that if the values of an examination arechanged, it applies to all examinations of the group.



2.5.2. Change the structure of exposures

There are various options to change the structure of exposures within theselected body part:

FIGURE 55. Configuration of macros / examinations

New examination or marco can be catured within this body part

Shows whether and/or how the image isrotated or flipped after the exposure

Shows whether a black border is applied to this examination

Deletes newly captured or copied examinations from the organ structure

Moves the examination

Creates a copy incl. generator settings, etc.

If the tick is missing in the checkbox, the examination is not available for planning

NOTE

To copy an examination or macro including all values andsettings just click on the copy button on the accordingexamination.

NOTE

It is not possible to delete standard examinations but tomake them not available for planning by removing the tickfrom the checkbox. Only the copy of an examination can bedeleted.



2.5.2.1. Move examinations

To change the order of the examinations, each examination has to bemoved separately to the required position. With a click on the „moveexamination“ icon, the examination will be displayed in a green colourand can be detached from the list.

FIGURE 56. Move an examination

When the examination is displayed at the required position in the list, asimple left mouse click inserts it at the preferred position.

2.5.3. Create a macro

Macros are very useful for simplifying the planning of recurringexamination processes, e.g. screening examinations, organs in more thanone plane, etc. The intention is to combine all the necessary exposures for anexamination within one macro. When the macro is used at a later stageto plan an examination, the system will automatically enter the savedexposures into the joblist of exposures to be taken in this examination. This saves a lot of time, since the user does not have to plan eachindividual exposure every time. To capture a new macro, proceed as follows:

•Click on the button „Create new macro“•Enter the name of the macro; the name will appear on the newlycreated button

•Click on the button „Add examinations“

Moves the examination to the preferred position



•Select successively all examinations, which should be displayedwith the macro

•Change the sequence of the planned examinations (if required)•Click on the button „Finished“•Use the new macro that is available for planning

FIGURE 57. Create a macro

Adds new examinations to the macro. After all examinations have been added, press „Finished“ to conclude the capturing of new examinations for this macro

Added exposures to the macro. Their order can be changed by using the arrow buttons

Newly created macro Enter the name for the new macro



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-67-

Chapter 3.The dicomPACS®DX-R Viewer

The built-in viewing application opens at a click on thebutton depicting an eye.

The viewing application is divided into four different sections: - The navigation bar is located on the left side

- The toolbar is located on the right side

- The working area is the main screen in the middle of theapplication

- The information bar is located at the bottom

To return to the console, press the „back“ button inside the viewer.

Figure 58. Viewing application

Toolbar

Most important tools can be activated by clicking on the toolbar buttons.The function of a button is displayed as a short tool tip when the mousemoves over the button.

Working area

All loaded images are displayed in the working area and are available forediting.

Navigation bar

Information bar Toolbar

Return to the console

Working area


-68- 3.1 The toolbar - general handling

Navigation bar

All opened images are visible on the navigation bar, even when notdisplayed in the working area.

Information bar

All important information such as patient data, etc. is displayed on theinformation bar.

3.1. The toolbar - general handling

The toolbar is divided into separate tool areas. Each tool area contains anumber of tools belonging to a thematic group. The tool area„annotations” for instance, contains all tools for the measurement ofimages.

All settings can be adjusted by clicking on the symbol with the twoarrows in the respective area. Tools whose buttons are not directly

visible on the toolbar can still be used by clicking on the button in theconfigurator or by using a keyboard shortcut.

Figure 59. Configurator

Depending on requirements and usage, the buttons visible in the toolbarareas can be hidden or shown (by ticking the checkbox next to thebutton). They can also be allocated to a keyboard shortcut. In order toenter the desired shortcut, position the cursor in the field next to thebutton and enter the shortcut via the keyboard (e.g. C or Alt+C).

Shows / hides the configurator

Tool area

Keyboard shortcut

Shows / hides button on toolbar

Tool (button)

Hides configurator

Additional configuration menu


3.1 The toolbar - general handling -69-

If there are too many tools selected for the toolbar area, then this ismarked with red rectangles around the already selected tools as well asthe preferred tool chosen to be added to the toolbar. In this case a toolfrom the selected or other toolboxes have to be deselected to get spacefor a new button.

Figure 60. Customising toolbar - too many selected tools

A further important element of the toolbar is the overview area. It showsthe displayed image in the working area as an overview.A green frame in the overview area marks the part of the image currentlyvisible in the working area. The visible area can be moved in two ways:

1. with the left mouse button held down in the working area2. with a single mouse click in the overview area.

When the cursor is positioned in the overview area, the zoom factor canbe adjusted using the mouse wheel. The percentage figure in the image (here 54%) shows the current zoomfactor of the active image compared to its original resolution in pixel. At100%, a pixel on the screen corresponds to a pixel in the original image.

PRACTICAL HINT

This is an uncomplicated way of customising the userinterface and the availability of tools for individual needs.

When selecting too many tools for the toolbar, they are marked with red rectangles



Figure 61. Overview of the current image

Please activate the image to which the tool should be applied.Afterwards apply the tool with a left mouse click or by pressing theallocated keyboard shortcut.

Patient name

Current zoom factor

Image area visible in the working area

Positioning frame

PRACTICAL HINT

The tools described on the following pages are divided intotwo types requiring different handling:

•Mouse tools (such as measurements and the magnifyingglass which have to be activated and can then be used withthe mouse in the working area)

•Tools operated by a simple click (such as rotations or thedisplay of a specific grid in the working area)



3.1.1. Tool area annotations

Figure 62. Annotations

The section annotations provides a wealth of tools for the measurementof images as well as for the drawing of annotations. The user mayfurthermore define keyboard shortcuts for accessing the annotations.

Measure distance - measure a length

By clicking on this button, it ispossible to measure thedistance between two points in

the active image. Left click on the starting point, holdthe mouse button down and move the mousepointer to the ending point of the distance to bemeasured, then release the mouse button.

CAUTION

During the process, the current distance is displayed inmillimetres (mm). If no reference scale has been saved in theimage (in the DICOM header), the length will not bespecified and is displayed as pixel.

Just the measuring line will be drawn. An unlimited numberof measurements may be taken before a different tool isselected.



Measure angle - measure an angle

Left click with the mouse onthe starting point of the firstleg of the angle (first line), hold

the mouse button down and drag the pointer to theend of the first leg. Then release the mouse buttonand repeat the process for the second leg of theangle. The angles measured will be displayedimmediately (acute and obtuse angle). The legs donot have to touch, facilitating the measurement of Cobb’s angle (forcalculations on the spine).

Measure obliquity - measure vertical and horizontalobliquity

By clicking on one ofthesebuttons, e.g. the angle of thepelvic obliquity can bedetermined in the active image.Left click on the starting point,

hold the mouse button down and move the mousepointer to the ending point of the line to bemeasured. Then release the mouse button. For ahorizontal obliquity, a dashed horizontal line is displayed for the basis ofdetermining the angle. For a vertical obliquity, a dashed vertical line isdisplayed as the basis for determining the angle.

The horizontal and vertical direction always refers to the monitormounting, regardless of how the image has been rotated.

NOTE

The angle between the plotted and the dashed line is shownin degrees °.



Text - enter text into an image or document

After selecting this tool,placethe pointer in the position in theimage or document where the

comment should be added. A left click will produce asmall white field in which text can be written. Bypressing Enter the field is closed and the textappears semi transparent. The text may only beviewed with dicomPACS®DX-R and dicomPACS®.

Draw arrow - draw arrows in an image or document

After selecting this tool, placethe pointer in the position inthe image or document where

the tip of the arrow should appear. The length andthe direction of the arrow can be determined withthe mouse button held down. The arrow is definedwhen releasing the mouse button. A small whitefield for entering text appears at the end of thearrow. By pressing the input key (Enter or Return), the text appears semitransparent. For an arrow without text, press the input key withoutentering text.

Multi line / polygon - measure the length of an irregularshap

Measure an open shape:Activate the tool by left clickingon the button. Left click in the

working area on the starting point of the shape tobe measured. Then click on the second corner pointand continue until you have reached the preferredshape. Double click on the last point to be includedin the shape. The current accumulated length isalways displayed during the process, and the total length is displayedafter double clicking on the last point. To display the length, the toolmeasure distance may be applied, see page 71.Measure a closed shape: Activate the tool by a leftclick on the button. Afterwards click in the workingarea on the starting point of the shape to bemeasured. Then click on the second corner point ofthe shape, and continue until you have reached thepreferred shape. The current accumulated length isalways displayed during the process. To close theshape, bring the mouse pointer near the startingpoint. When all points are marked with small squares, left click once toclose the polygon.



Draw ellipse - draw an elliptical shape

After selecting this tool, leftclick on the starting point (onecorner of a hypothetical

rectangle surrounding the circle or ellipse) hold themouse button down and drag it to the oppositediagonal corner of the rectangle. The ellipse isdefined on release of the mouse button. At the endof the ellipse a small white field appears where textcan be entered. By pressing the input key (Enter or Return), the text isshown semi-transparent. For an ellipse without text, press the input keywithout entering text.

Density within a line - measure the density over a line

When the tool is activated, thedensity value of the pixelcurrently under the pointer is

shown. Left click on the starting point of themeasurement, hold the mouse button down anddrag it to the end of the line. On release of themouse button, the average density over themeasuring line is immediately displayed next to itimmediately after releasing the mouse button.

Density within a rectangle - measure the density over arectangle area

When the tool is activated, thedensity value of the pixelcurrently under the pointer is

shown. Left click on the starting point (one corner ofthe rectangle) hold the mouse button down anddrag it to the opposite diagonal corner of therectangle. The average density over the area isdisplayed next to it immediately after releasing themouse button.

PRACTICAL HINT

If a keyboard shortcut for the zoom tool (e.g. the key “+”) isdefined, it can easily be used to zoom into the image tofacilitate accurate drawing.



HD measurement - determine the disorder of hip joints indogs

HD is a disorder of the hip jointin dogs, which particularlyaffects larger breeds. A reliable

way to detect the severity of the disease is possiblewith the HD measurement tool, which measures theangle (Norberg angle) between the center of thefemoral head and the anterior acetabular margin. Byclicking on the icon of the HD measurement the toolis activated. By moving the individual points, lines and circles, themeasurement is properly placed. The length of the distance between thecenters of the circles is given in millimeter and the area of the circles isgiven in square millimeters. If the image is not calibrated (e.g. wrongpixel values in the DICOM header), the length of the distance and thearea is not shown.

Centerline - insert a centre line to determine thediaphyseal axis

By activating this function, acentre line for the determinationof a diaphyseal axis is inserted.

Position the mouse pointer near the end of thecentre line. Once it is displayed in the „active” colour(e.g. red) and the small squares mark its corners, clickon the corner point to be moved. The point can bepicked up and moved to a new position with the leftmouse button held down.To move a centre line, position the mouse pointer in its middle. Once it isdisplayed in the „active” colour (e.g. red) and no small squares mark itscorners, it can be moved as a shape without changing its size or angle.Hold the left mouse button down and drag the centreline to the requirednew position. Release the mouse button to display the centerline.

Centercircle - determine the centre of objects

The annotation can be used todetermine the centre of anyobject, e.g a femur head. The

tool is activated and inserted by clicking on the iconfor the centercircle in the annotation toolbox in theviewer. Position the mouse pointer near circle line ofthe centrecircle. Once it is displayed in the „active”colour (e.g. red) and a small square marks its corner,click on the square to change the size of the circle by holding the leftmouse button down and moving up or down.



To move a centrecircle, position the mouse pointer in its middle. Once itis displayed in the „active” colour (e.g. red) and a small cross marks itscentre, it can be moved as a shape without changing its size. Hold theleft mouse button down and drag the centrecircle to the required, newposition. Release the mouse button to display the centercircle.By a double click on the attached text field, a dialogue box appears tochange the settings of this annotation.

FIGURE 63. Settings of the centercircle

Edits the centerpoint of the circle

The diameter of thecircle can be shown

Edits the usage ofcircles with fixed size



Centerpoint - determine a centre point

Use this annotation, e.g. todetermine the centrepoint of aknee. After inserting the

annotation it can be edited as follows:Position the mouse pointer near the end of theannotation. Once it is displayed in the „active” colour(e.g. red) and the small squares mark its corners, clickon the corner point to move it. The point can be picked up and moved toa new position with the left mouse button held down. Once it is displayed in the „active” colour (e.g. red), it can be moved as ashape without changing its size or angle. Hold the left mouse buttondown and drag the annotation to the required new position. Release themouse button to display the centerpoint.

Corrective osteotomy - determine the hip-leg statics

By clicking on this button, acomplex annotation appears todetermine the hip-leg statics. It

consists of a centreline, an annotation to determinethe centrepoint of the knee, and an annotation todetermine the statics. This annotation may be usedand moved in the same way as the otherannotations.

Insert TPLO measurement - measure the angular of thetibia plateau

The TPLO (Tibial Plateau LevelingOsteotomy) measurement allowsthe angular measurement of the

tibia plateau.The tool is activated and inserted byclicking on the icon for the TPLO measurement in theannotation toolbox in the viewer. The configurationof the midpoint is carried out at the hock and at thejoint, which are connected by a olive green line. The user shall set a pointat the frontal and the back border of the tibia plateau to get a resultingline (olive). The line, that is shown in green and which is locatedrectangular to the first line, allows the slope measurement of the medialtibial condyle.



Figure 64. TPLO measurement

Insert TTA measurement - measure the parallel-shiftedlength at the tibial tuberosity

The TTA measurement is used forthe measurement of the parallel-shifted length measurement at

the tibial tuberosity.The tool is activated and inserted by clicking on theicon for the TTA measurement in the annotationtoolbox in the viewer. The three points of the TLPOserve as the basis of the circle (M1). Two other circles (M2, M3), eachwith variable centers and radius have to be drawn.

Point on the joint

Point on thefrontal tibiaplateau border

Point on the backtibia plateauborder

Midpoint

Rectangular line and resulting slope



The middle of the distances between M2 and M3, together with M1make line L. Two additional lines, that are rectangular to each other,allow the a parallel-shifted length measurement at the tibia tuberosity.

Figure 65. TTA measurement

Adding of the TPLO/TTA measurement

It is possible to add the TPLO, respectively the TTA measurement to theimage. By double clicking on the writing „TPLO/TTA measurement“within the image to be edited, a selection box allows to display the TLPOand / or the TTA measurement.

Figure 66. Choice of adding the TPLO/TTA measurement

M2

M3

M1 L

Parallel, straight line to L for length measurement at the tibia tuberosity

Result of the lengthmeasurement

Line L connecting themidpoints

Circle through the three points (TPLO)

Two different coloured circles with varying radius

Rectagular line



Distractions index - measure the looseness of the hipjoints

The distraction index measuresthe looseness of the hip joints.The tool is activated and inserted

by clicking on the icon for the distractions index inthe annotation toolbox in the viewer. The degree ofdisplacement of the femoral head from theacetabulum of the hip joint in relation to the radiusof the femoral head is determined by two circles.The green circle is placed on the femoral head and the red circle on thejoint socket of the hip joint to get the result.

Figure 67. Distraction index

Cross distance measurement - determine the crossdistance

By activating this tool it ispossible to draw two linesrectangular to each other to

measure the cross distance. The lines can be movedby clicking on the small squares that mark itscorners.

Red circle to fit the joint socket

Result

Green circle to fit the femoral head



Buchanan‘s Vertebral Heart Score - determine the size ofthe heart

This annotation is a simple andreliable method to determine thesize of the heart.

It has been designed specifically for cats and dogs.The height and width of the heart are put intorelation to the individual animal’s vertebral bodywidth. Therefore, racial distinctions are brought tobear on the examinations results. The Vertebral Heart Score (VHS) ismeasured by the long axis (L) and the short axis (S) which are transposedonto the vertebral column and recorded as the number of the vertebraebeginning with the cranial edge of T4.

Figure 68. Buchanan‘s Vertebral Heart Score

Draw blackborder - draw a frame for a black border

The digital X-ray process usuallycreates troublesome whiteborders around the image.

These white borders can be cut and darkened byusing the black border annotation. The saturation of the black border can be configuredby an authorised software dealer. It can be set fromslightly dark to 100% black.

Measure lines beginning from T4

Heart measurement, maximum length (L) and maximum width (S)



By clicking on the button, a frame can be drawn around the region ofinterest. After activating the button, click with the left mouse button onthe upper left corner of the displayed region of interest. Drag the mouseto the end of a line and then press the left mouse button again. Whenmoving the mouse, a rectangle is formed. Once the rectangle hasreached the desired size, click the left mouse button again. The image isshown immediately with the activated black border. To edit the blackborder, click on the black border button again. The black border turnsblue and the rectangle can be adapted by the displayed additional guidearrows.

If the mouse pointer is positioned near a corner of the rectangle, therectangle and the guide arrows turn red. With the mouse pointer on theguide arrows and the left mouse button held down, the rectangle can berotated around its opposite corner. The size of the rectangle can bechanged with the left mouse button held down on the respective cornerof the rectangle. Once the frame is in the desired position, the blackborder can be activated by clicking on the button„Activating and deactivating the black border“.The digital X-ray images in this section are shownwith a drawn frame; a black border function isdeactivated and activated respectively.

Edit an annotation - change measurements

After selecting the tool, move the mouse pointerclose to the measurement or annotation to beedited. As soon as it is displayed in red, several

options of editing are available:

First option: move the complete shape

Position the mouse pointer in the middle of theshape to be moved (line, ellipse, etc.). Once this isdisplayed in the „active” colour (e.g. red), it can bemoved as a shape without changing its size orangles. Hold the left mouse button down and dragthe shape to the required new position. Release themouse button.

NOTE

The performance of the black border of the toolbar in the X-ray view differs from the annotation draw black border in theviewer. In the X-ray view, the black border is disabled once acertain size of the black border is reached.



Second option: move the edges of an element

Position the mouse pointer on an edge of theelement to be moved (line, rectangle, etc.). Once thisis displayed in the „active” colour (e.g. red) and nosmall squares mark its corners, the edge can bemoved as a shape without changing its size orangles. Hold the left mouse button down and dragthe edge to the required new position. Release themouse button.

Third option: move a corner point

Position the mouse pointer near the corner of theelement to be edited (line, rectangle, etc.). Once thisis displayed in the „active” colour (e.g. red) and thesmall squares mark its corners, click on the cornerpoint to be moved. The point can now be picked upand moved to a new position with the left mousebutton held down. Release the mouse button.

Fourth option: mark, move and rotate elements

Position the mouse pointer near the element to bemarked (line, ellipse, etc.). Once this is displayed inthe „active” colour (e.g. red), the element can bemarked. Click on the element with the „Shift“ keyheld down. The line of the element turns in a reddashed line when it has been marked. Furtherelements can be marked in the same way.The marked elements can be moved or rotated as anentity.To move marked elements, hold the left mousebutton down and drag the shape to the requirednew position. Release the mouse button.With the „Ctrl“ key and the left mouse button helddown, the marked elements can be rotated aroundits centre of gravity.To remove the marking, click next to the element without pressing a key.



Fifth option: rotate elements without prior marking

Position the mouse pointer near to the element to berotated (line, ellipse, etc.). Once it is displayed in the„active” colour (e.g. red) and no small squares markits corners, the element can be rotated with the„Ctrl“ key and left mouse button held down.

Annotations on/off - hide / show measurements andannotations

With a click on the button, all measurements andannotations are hidden or shown.

Remove an annotation - delete single measurements

After activating this tool, bringthe mouse pointer over themeasurement or annotation to

be deleted. All lines, arrows and texts appearing inred as well as the black border tool will be deleted bya left mouse click.

Clear all annotations - delete all measurements andannotations

With a click on this button, all measurements andannotations are deleted, except the black bordertool.

Position marker - insert left / right position marker

By clicking on one of these buttons, an „L” or „R”,for „left” and „right”, can be inserted in therespective position in the image, e.g. in case it hasbeen forgotten when the image was taken.

NOTE

Please note that the action of deleting all annotations cannotbe „undone”.



Blackborder on / off - de- /activate blackborder

The digital X-ray process usually creates troublesomewhite borders around an image. By clicking on theblackborder on/off button, a black border frame can

be activated and deactivated. If the black border is activated, the whiteborders around the image are coloured black. When the black border isdeactivated, the white borders around the image will be displayed again.

Add image label - add a label to the image

By selecting the add image label function, it ispossible to enter a text directly into an image. Allother annotations are saved as overlays and can be

faded out. To activate this annotation, click into the image, whereby adialogue box opens. Inside the dialogue window the font, font colourand the font-size can be adjusted. Furthermore, it is possible to choose apredefined label and the text background.

Figure 69. Add image label

Burn in study information - add study information to theimage

It is possible to burn in IDdata in a study. Thephysician, the patient, the

study description, the date and the time of theimage acquisition can all in once be burned in the



current image. The user may also select the burn-in for all images of theselected study in the configuration mode in the tab „Image processing“when configuring examinations, see page 59. Each entry can be moved with the left mouse button held down.

3.1.1.1. Configuration dialogue of the annotations

The configuration dialogue appears by selecting the screw wrenchicon and offers the settings for the specified tools.

Configuration of the image label

In this configuration dialogue it is possible to predefine image labels. It ispossible to individualise the label to the user‘s needs by defining fontsizes and predefining texts.

Figure 70. Configuration dialogue box Add image label

The font size in millimetres is used for calibrated images and the font sizein pixel is used for not calibrated images. For both options it is possibleto define three size steps (large/medium/small). This preselection and thepreselection of the fonts are used for the according tool. To predefine alabel enter the text into the input field and press the plus button. Thetext then appears in the list with predefined image labels. For removinglabels from the list select the entry and press the minus button.

Predefine image labels Display font sizePredefine font selection



Configuration of the Flipped Hint

With this dialogue it is possible to configure the size and the font of thehint that the image is flipped.Each change is directly displayed in the preview.The possible font size has a range from 4 to 16 mm; and a great varietyof different fonts can be selected.

Figure 71. Configure the hint of a flipped image

Configuration of the annotation colour

With this configuration dialogue, the colour of annotations can beedited as well as the font and the line width according to the user‘spreferences.

Preview shows the new settings Select the font for the hint

Determine the size of the font



Figure 72. Configuration dialogue for colours

If the checkbox next to „Colour“ is ticked in the section activemeasurement(s), the active colour can be changed by clicking into thecolour palette.

Figure 73. Colour selection

Edits the colour of the active measurement

Selects the line widthSelects the font and character size

Edits the colour for single annotations

Changes the colouras selected

Selects all

NOTE

The active annotation colour is the colour which is shownwhile drawing and editing the annotation; the standardcolour is the colour in which the annotations are displayedafter the completion of the drawing.

Active colour

Standard colourDemonstrates how well theselected colour is visible



If an image is shown in the viewer, sample annotations are displayed inthe active colour when the colour box is ticked. When the colour ischanged, it is made immediately visible in the viewer.In order to change a colour for more annotations, the check boxes of theappropriate annotations next to „Colour“ must be ticked. If an imagewithout annotations is displayed in the viewer, a sample annotation isshown.

Additional XOR-Colours can be assigned to the annotations. The use ofXOR-Colours is especially suitable for images on b/w monitors. Becausethe shades of grey in an image may differ considerably, it can be difficultto set a colour for a line that is clearly visible in all parts of the image. Byusing XOR-Colours, the line adapts to its environment; i.e. in a dark area,the line becomes brighter, while in a bright area, the line becomesdarker.The XOR-Colour results from a synthesis of the following three colours:

1. the current colour used for the annotation (selected as„Colour“)

2. the colour selected as XOR-Colour

3. the current colour of the pixel (the background colour on whichthe annotation is drawn)

For example, when drawing in a red colour on a white pixel and a greenXOR-Colour is selected, the annotation is shown in blue.After ticking the check boxes next to XOR-Colour, the XOR-Colour can beselected colour palette. When clicking in the check box next to XOR, theXOR-Colour for the respective annotation is used; i.e. the annotation isdisplayed in the colour that results from the XOR function. In order to set the XOR-Colour and/or the use of the XOR-Colour for allannotations, the respective button can be clicked on. All check boxes areactivated and/or deactivated.By clicking on the colour selection field, the colour of the selectedannotation and/or the XOR-Colour can be changed.

PRACTICAL HINT

By clicking on the button with the two pins below the colourselection boxes, the colour of all annotations can beprocessed at the same time. With another click on thebutton, the check boxes are cleared again.



Figure 74. Font and line configuration

In the section „Selection of the font“, the favoured font can be selected.The font size can also be selected or directly typed into the selection field.Changes to the font are immediately visible in the sample text below.The line width of the annotations can be selected in the section„Selection of the stroke“ by clicking into the round boxes next to thedifferent line widths.

Changes the font

Changes the linewidth

Demonstrates theeffect of theselected values



Configuration of the position marker Left/Right

In this configuration dialogue, it is possible to predefine the positionmarkers.

Figure 75. Configuration dialogue box of position marker Left/Right

To predefine a position marker activate „Select Text“ and define thesettings. Otherwise the default marker will be used. Enter the new textinto the input field and select the font which should be used. The fontsize can be changed, also the background of the text can be set black ortransparent. Additionally the size of the marker can be edited. Therefore,simply change the value. The images must be calibrated so the specificsize of the marker can be used.

Configuration of the overlays

In this configuration dialogue, the overlays for all or for different outputdevices (e.g. monitor, print and export) can be edited. Overlays areinformation that is incorporated in DICOM images, like e.g. patient data,modality, creation date and further examination-related data. The following image shows examples of different overlays.

Select the display fontInsert the new text

Select the backgroundPreview of the result ofthe changed settings

Size of themarker



Figure 76. Image including overlays

If for example a CR image is loaded, the overlays for all CR images areconfigured. When exiting the dialogue, the CR image is shown with thenewly configured overlays.

Overlays in an image with information of thestudy date, study description, modality, etc.



Figure 77. Configuration dialogue for overlays

Overlays can be configured for all output devices (monitor, print andexport). The button for all devices is activated and the buttons for thespecific devices are greyed out and cannot be selected. If something ischanged, it affects the display of the overlays for all devices. There is onlyone configuration file (XML file) that is generated.The display of overlays can also be configured separately for therespective devices. The button for all devices has to be deactivated by leftclicking on the mouse. Afterwards the configuration for the monitor isshown. By clicking on the according buttons, the respectiveconfiguration can be displayed and edited. A configuration file (XML file)is created for each device. In order to return to the display for all devices,the according button is again to be activated. After that the files for thedifferent devices are deleted.By clicking on the „Default“ button, the standard configuration of theoverlays is displayed. From here, new changes can be entered.When the button „Edit + Add“ is selected, text can be written into thelines with a mouse click. The text is shown in black. When right clickinginto a text field, a pop-up menu appears from which the overlay tag canbe selected.

Xml file beeing edited

Edits, adds and/or removes rows

Editing area for overlays

Configures different devices



Figure 78. Example of an overlay tag

Clicking again outside the pop up menu before selecting another tag willclose the pop up window without applying any changes.Clicking on the „plus” button (+) before clicking in the text field willinsert a new line below the text field.When the „Delete“ button is selected, a „minus” button (-) appearsbefore the text field.If there is more than one row at a given position (e.g. top left), the entirerow is deleted by clicking on the „minus” button. If there is only one rowat a position, only the contents of the row is deleted; the text field is notdeleted so that new entries can be inserted.By clicking on the button „Deletes all“, all text fields are deleted, so thatno overlays remain. All rows are deleted and an empty text field appearsat each position.

3.1.2. Tool area turn / mirror

NOTE

An overlay tag is a part of the information stored in theimage, e.g. patient data or study data. The overlay tag isshown in light grey. If no overlay tag is to be inserted, thepop up menu can be closed by clicking outside of the pop upwindow or by pressing the „Esc“ key. If a tag is alreadycontained in an overlay tag field (black background), the popup menu appears at a left or right mouse click. The overlaytag can be changed.

Overlay text fieldPlus marks „Edit + Add“ mode



Figure 79. Turn / mirror

Images can be rotated by 90° clockwise or counterclockwise as well asflipped horizontally or vertically. By clicking on „reset orientation”, the image returns to its originalorientation. The user may furthermore define keyboard shortcuts for accessing theturn/mirror tools.

3.1.3. Tool area grid

Figure 80. Grid

In the tool area grid, the user may divide the working area into variousgrids, for example to compare images. The user may furthermore definekeyboard shortcuts for accessing the different grid options.

3.1.3.1. Configuration dialogue for grids

The grid configuration dialogue offers the opportunity to create a gridfor the viewer display as well as for series. Thus, it is possible to useindividually configured grids for the toolbar. The display of the grid icons

NOTE

A qualified service engineer can easily configure even largergrids.



and descriptions can be changed between „row x column“ and „columnx row“. By using the configuration dialogue, it is possible to deleteexisting grids or those that are configured incorrectly. To create a new grid, the configuration dialogue has to be opened,therefore select the screw wrench icon at the left lower corner inside thetoolbar menu of the grid section. When clicking on the icon, thefollowing configuration dialogue opens.

Figure 81. Create and configure grids

All existing grids are displayed inside the dialogue according to series orto a display. A new grid can be configured or the display of the grid iconsand descriptions can be changed. After the changes have been made,close the dialogue using the „Save“ button.

Create and add a new grid

To create a new grid it must be drawn inside the section „Creation of agrid“, e.g. a 2x5 grid. For drawing a grid in the specified area, press theleft mouse button in it and drag the mouse to select the preferred gridsize. The grid size is immediately shown next to the drawing area on theleft.



Figure 82. Draw a new grid

When the preferred grid is drawn, it should be added to the displaysection or to the series of the graphic displays. Press the „+“ buttonbesides the according section (marked red in the image below).

Figure 83. Add a new grid

The grid is added and available inside the toolbar menu of the gridsection immediately after adding it.

Figure 84. Toolbar menu of the grid section

The newly configured grid can be used like the default grids.

Display option of the grid



The user may switch between the display option of the grid icons anddescriptions, which means to switch between „row x column“ and„column x row“. All grids are displayed as „row x column“ by default.

Figure 85. Configure the display option

To change the display option, select the preference by pressing theaccording button.

Delete a grid

To delete a grid, open the configuration dialogue of the grid section.Select the grid to be removed and press the „x“ button next to theaccording section on the right (marked red in the image below).

Figure 86. Delete a grid



3.1.4. Tool area brightness

Figure 87. Brightness

In the tool area brightness, the user can configure the perceivedbrightness of an image. The user may furthermore define keyboardshortcuts for accessing the brightness tools.

3.1.4.1. Brightness tools

Original image - Reset the image to default

With a click on the original image button, allbrightness changes (dynamics) are reset to thedefault setting and the original image is displayed.

Gamma ++/-- - Change the perceived brightness of animage

NOTE

The function of the brightness buttons in the X-ray viewdiffer from the tool are brightness in the viewer. In the X-rayview, the values are assumed when the image is accepted. Inthe tool area brightness this is not the case.

PRACTICAL HINT

The window levelling can be adjusted by pressing the rightmouse button and moving the mouse up and down, seepage 99.



The gamma ++ and gamma -- tools allow the userto brighten or darken the image. This is achieved bychanging the dynamic range of the image (gammacurve).

3.1.4.2. Configuration dialogue of the brightness tools


Colour LUT

It is possible to define coloured LUT. The preset blue is the default settingand can be deactivated or configured in this dialogue. Therefor it isnecessary to login to unlock the controls.

Figure 88. Colour LUT tab

Login field to unlockthe configuration

Other tabs for theconfiguration

Current windowlevel values of theimage



Histogram

The window level values are shown and can be adjusted in thishistogram by moving the coloured, vertical line.

Figure 89. Histogram tab

Monitor LUT

The monitor LUT can be used to adapt the grey values of the monitor ifnot realised by the graphic card or the monitor directly.

Figure 90. Monitor LUT tab

PRACTICAL HINT

To use this tool it is advisable to enlarge the dialogue bydragging the corner holding the left mouse button down.This is useful to get a more detailed histogram.



3.1.5. Tool area image selection

Figure 91. Image selection

In the tool area image selection, the user can configure the tools whichfacilitate to work with the images in the viewer. The user mayfurthermore define keyboard shortcuts for accessing the image selectiontools.

3.1.5.1. Image selection tools

Standard cursor - default cursor

The selection of this tool deactivates the last selectedtool and returns the default mouse pointer.

Tools for right mouse button - allocate a tool to the rightmouse button

The right mouse button can be used for threedifferent functions: magnifying glass, windowlevelling (brightness and contrast) and zoom. Each

function can be selected from the configurator and in addition, the usermay define keyboard shortcuts for the different functions.

PRACTICAL HINT

It may be useful to allocate the key „Esc” to this tool, so thatthe default mouse pointer will always be displayed bypressing „Esc”.



Figure 92. Tools for right mouse button

Select image - select an image (pick-up tool)

With the activated pick-up tool, images can beselected on the navigation bar or within the workingarea. Serial numbers are allocated to the selected

images which are shown in yellow at the upper left corner in the workingarea next to the pick up icon. The purpose of this function is to prepare aselection of images for further use, i.e. printing or export. The size of theimages that have been picked up with the tool is also shown in theinformation bar on the right next to the pick-up icon, see page 99. Thedisplay is convenient e.g. when burning CDs in order to know the size ofthe data.

Deselect all images - remove a selection

This tool removes the selection and serial numbers ofall images with one click.

3.1.5.2. Configuration dialogue for the image selection tools

By selecting the screw wrench icon, the configuration dialogue ofthe quick access menu is displayed. In this dialogue it is possible toassign the quick access menu to the middle mouse button by

clicking on the corresponding checkbox to activate the function.

Selects the magnifying glass

Selects window levelling

Assignment of shortcuts

Selects the zoom function

Quick access menu availablewith right mouse button



Figure 93. Configuration dialogue of quick access menu

3.1.6. Tool area magnifier / zoom

Figure 94. Magnifier / zoom

In the tool area magnifier/zoom, the user can configure the zoom tools.The user may furthermore define keyboard shortcuts for accessing thezoom tools.



3.1.6.1. Magnifier / zoom tools

Magnifier - mouse pointer as magnifier

The magnifying glass is activated by clicking on thisbutton. The activation of tool is indicated by a mousepointer in the shape of a magnifying glass, which can

be moved across the image. When the left mouse button is held down,the magnifying glass takes effect. The magnification is always 100%above the zoom factor of the displayed image. If the image is displayedat zoom factor 100% (original resolution), the area within themagnifying glass is displayed at a zoom factor of 200%, i.e. enlarged by100%. When the tool is active and the left mouse button is held down,the user may also select the preferred masking of the magnifier asdescribed in the help text.

Figure 95. Magnifier with selectable masking

NOTE

The magnification process is based on the interpolation ofpixels in order to achieve the impression of a smooth image.



Zoom: 100% - 100 percent representation of the image

After activating this tool, the active image is set to itsoriginal resolution within its current grid area. Thismeans that each pixel of the displayed image is

displayed as exactly one pixel on the screen. The image is displayed in theoriginal resolution, which means that the complete image information isshown. This tool is especially important for all images whose original resolution isgreater than it can actually be displayed on a screen, e.g. digital X-rayimages. These images are generally scaled down in order to display themas a whole, so that only part of the image information is shown. It is veryimportant to view all of the information when making a primarydiagnosis. This can be achieved by clicking on the 100 % button.Certainly it is possible to enlarge the image further by using the zoomtool.

Zoom - Zoom +/- (in / out)

When clicking on one of thesebuttons, the active image isenlarged or scaled down in pre-

determined steps. The same is achieved by:•pressing the right mouse button and turning the mouse wheel•placing the mouse pointer in the overview image and turning themouse wheel or

•holding down the „Ctrl“ key and turning the mouse wheel whilethe image is activated in the working area.

Fit image - fit an image to the grid area

When pressing on this button, the entire activeimage is displayed in its grid area and fitted to its size(e.g. it is scaled down or enlarged).

PRACTICAL HINT

By default, the magnifying glass is activated with the leftmouse button and moving the scroll wheel. The user mayhowever also allocate this tool on the right mouse button, ifno other tool (e.g. window level) should be activated via theright mouse button – please see the section tool area imageselection for further information on page 99.

NOTE

The 100 % representation of the image does not conform tothe actual size of the depicted object (measured in cm orsimilar) but only to the resolution of the imaging device (CR,DR).



Fit width - fit an images to the grid width

By clicking on this button, the currently active imageis fitted to the width of its grid area.

Black border on/off - activate and deactivate the blackborder

The digital X-ray process usually creates troublesomewhite borders around an image. By clicking on theblack border on/off button, a black border frame can

be activated and deactivated. If the black border is activated, the whiteborders around the image are coloured black. When the black border isdeactivated, the white borders around the image will be displayed again.

NOTE

In the toolbar, the currently active image is shown as anoverview. Here it is easily visible whether the black border isactivated. If it is, the border is represented by hatching. If theblack border is deactivated, the image is shown as when itwas taken.



Display filmidentical

By clicking on this icon the current image isdisplayed filmidentical, that means in the samescale like on conventional x-ray film. To use this

tool it is necessary to calibrate the monitor. This can only be done withadministration rights.

Figure 96. Display filmidentical

3.1.6.2. Configuration dialogue of the magnifier/zoom tools

By selecting the screw wrench icon, a configuration dialogue forthe magnifier and zoom tools is displayed.

The tab Interpolation may only be configured by the administrator.



Figure 97. Configration tab Interpolation

In the tab magnifier, it is possible to configure the magnifier size in pixel,the magnification and the display of the help text.

Figure 98. Configuration tab magnifier

There are several ways to zoom into images. In the configurationdialogue of the toolbox magnifier/zoom you can find the tab Zoom toolsand Zoom to individualise the zoom options.



In the tab Zoom tools, the user can configure any number of new zoomtools, which enlarge the image by the set zoom factor, e.g. 35%. Thisworks analogue to the already available 100% zoom tool.

Figure 99. Configuration tab Zoom tools

In the tab Zoom, the user can set the zoom factor by which the image isenlarged when selecting the zoom tool. The user can also set the zoomfactor for zooming with the use of the mouse wheel + Ctrl key.Additionally, it is possible to zoom with the left mouse button + mousewheel and configure the zoom factor in the configuration dialogue.

Figure 100. Configuration tab Zoom



3.1.7. Tool area management

Figure 101. Management

The management tools allow working with the archive. It is possible tocreate a finding or to archive images on an external medium, using thepatient CD functionality. The user may furthermore define keyboardshortcuts for accessing the management tools.Using the configuration dialogue of this tool area, it is possible toconfigure or change the practice stamp or to edit the export directoryand formats.

3.1.7.1. Management tools

Export images

The export of images is initiated via the followingdialogue box after clicking on the icon for exportingimages.



Figure 102. Export images

The user can choose between exporting the current image, all selectedimages (which were selected with the select image tool of the toolboximage selection, see page 99), the current series or all loaded images. The file name of the data to be exported can be individualised by amanually given file name or an automatically generated name. Theappropriate option is to be selected.

If „manual file name generation“ is selected, the user simply has to writein the name of the data in the field file name.

The automatically generated option can be customised by selectingbetween given parameters that should appear in the file name.

The screw wrench button next to the data field „file name“ opens theconfiguration dialogue.

The following parameters, that form the file name, can be selected anddeselected by clicking on the checkboxes:

- ID- Last name- First name- Date of birth- Sex

Image selection

Selection of the targetfolder and file name

Selection of the image format

Option for the dataexport

Configuration dialogue



The export target folder can also be configured in the configurationdialogue.

Two options are possible:

- to always use the same given directory or - to set the last used directory as default

Figure 103. Configuration dialogue of exporting images

It is also possible to export just findings. Images can be exported in thefollowing formats:

•DICOM•JPEG•Bitmap•TIFF•PNG.

It is possible to choose more than one format for the export.

NOTE

The manual file name generation is always used for allimages that are loaded, irrespective if the data belongs todifferent patients.

Data export formats

Creation of the filename

Selection of the exportdirectory



If several images are exported, a number from zero to n (number ofimages) is added to the file name. The shown export formats in the export dialogue can also be configuredin the configuration dialogue by selecting or deselecting the relevantcheckboxes. Clicking on „save“ stores the selection.It is also possible to set different options for the export of images:

- export with overlays (image format JPEG, TIFF, Bitmap orPNG must be selected)

- export with annotations (image format JPEG, TIFF, Bitmapor PNG must be selected)

- anonymize/customize DICOM data (image format DICOMmust be selected, see page 131).

Print - printing of images

The printing dialogue permits selective printing ofloaded images via the installed Windows printerdrivers or DICOM printers (optional). Single images

can be printed by selecting them with the pick-up tool (see page 153). A print preview including the configured print margins are displayed onthe right hand side of the print dialogue. The print preview displays eachpage to be printed with its selected grid and considers the ratio of the setpaper / film and the orientation (landscape / portrait). The arrow keys leftand right in the print preview allow scrolling through the selected pages.

NOTE

All selected pages are printed as shown in the print preview.



Figure 104. Print configuration dialogue

In the print preview it is also possible to zoom into the image by scrollingthe mouse wheel and to pan the image by holding the left mouse buttondown.

While the print dialogue is open, the images can be processed further.Brightness and window level changes are transferred immediately to thedialogue, while zoom, filters, LUT and inverse representation are onlytaken up if the appropriate print options have been selected.The print layout is selected in the category „choose your page layout“.The grid is chosen and also whether the institution’s stamp is to beprinted at the top of the document or not.

Figure 105. Page layout

Select a printer

Select images tobe printed

Select the pagelayout

Number of theimage

Print previewPrint options

Printer configuration

Select paperorientation andsize

A ruler like thiscan be printedon each image

NOTE

The option print filmidentical must be deselected forzooming and panning in the print preview.

Page layout in 2x2 gridwith institution‘s stamp

Page layout in 2x2 gridwithout institution‘s stamp



If the images are to be printed in irregular grids or in a particular order, aspecific procedure has to be followed:

•At first, the images in the viewer must not be selected. The printdialogue is opened by clicking on the print button. A page withthe current image in the 1x1 grid is displayed as a preview in thedialogue. The grid is selected by clicking on the relevant gridbutton in the dialogue.

•The images are then displayed on the printing dialogue previewpage in that sequence. When the image in the last free grid field isadded to the preview page, the preview automatically jumps to anew page. After all images have been positioned they can still beedited further.

The images to be printed are numbered in sequence in the print preview. The following print options can be selected for the printout by selectingthe screw wrench icon next to the selected printer in the printconfiguration dialogue:

•Print with annotations:All added measurements, comments, arrows, etc. areprinted.

•Auto rotate image:X-ray images in landscape format, e.g. 35x43, areautomatically rotated by 90° for the printout.

•Current image selection:The images are printed in the size displayed in the workingarea with the zoom function.

•With image processing (filter, LUT and inverting):All image processing, e.g. the effect of filters, etc. is printed.

•Print filmidentical:The image is printed like on films by the selected printer.

•Print ruler:A ruler to confirm e.g. a distance can be printed on theimage.

When the print process is started by clicking on the print button, aprogress bar appears. It shows the progress of the printing process.

PRACTICAL HINT

To maintain a particular sequence of images when printing,the selection tool must be activated in the viewer and theimages marked in the required sequence.

NOTE

If the printing has not yet been completed, the use of theViewer and other functions is blocked.



The layout and print options can be configured for DICOM printer byselecting the screw wrench icon next to the selected printer.

Figure 106. Printer configuration - options

To print images filmidentical and to print a ruler confirming a distance onthe printed image, two checkmarks can be activated in the configurationdialogue above. For paper and film printer, calibrated images (DICOM or manuallycalibrated) can be printed so that its size is exactly the same as if theyhad been taken on the media. In addition, a scaling factor is specified forcalibrated images. This factor corresponds to the magnification of thefilmidentical print. This factor is given in percent. 100% corresponds tothe filmidentical print. Another option is to print the ruler. The scale andthe length correspond to the scaling factor.

Figure 107. Printer configuration - media

Several options forthe printing dialoguecan be shown or theones are shown thatare already selected

Select the availableorientation

Scrolls through thetabs of theconfiguration dialogue

Tabs of theconfiguration dialogue

List with differenttypes of print media

Configuration of thelisted types of printmedia



By selecting the screw wrench button next to the type of print media thathas been chosen, the above configuration dialogue below appears andallows to enter the preferred print resolution and to configure the printmargins manually.

Figure 108. Configuration of the print media

To confirm the changed setting, press the „Save“ button.

In the tab grids for images it is possible to create a new or delete selectedgrids in addition to the already available standard grid sizes. To create anew grid, click on the matrix on the right of the tab. By clicking in thefields of the matrix and holding the left mouse button down, the usermay draw irregular grids. It is also possible to create grids inside analready drawn grid, which are highlighted in different colours.By clicking on the „Add“ button, the drawn grid is added to the list ofavailable grids. Clicking the right mouse button removes the last clicked field. Bypressing the „Reset“ button the grid fields become empty.The slider below the matrix or turning the mouse wheel changes the sizeof the grid.The configuration of grids for documents is exactly the same as forimages.For specific requirements all layouts and print options can be configuredindividually by a technician.

Configurate the print marginsby using the slide controls

Configurate the print resolutionby entering other values



Figure 109. Printer configuration - grids for images

Patient CD - create patient CDs and memory sticks

This function copies all displayed or selected imagesto a CD or memory stick.

A free of charge version of an X-ray image viewer will be copied to theCD/DVD or memory stick to view the images. The possibilities of thisprogramme module are extremely versatile. There are various ways of using the patient CD tool. The tool facilitates tosave a list of images for copying it at a later stage, and to save images ona CD, DVD or memory stick. Existing list entries can selectively be deletedfrom the image list.

Slider to change thematrix size

NOTE

Before copying, please make sure that all images have beenassigned to the patient data. If this is not the case, you willbe notified in the dialogue.



Figure 110. Create patient CD

The image selection provides the choice between adding the currentimage, all selected images, all loaded images, or the current series to thedisplayed export list. The number of currently selected and loadedimages is shown in brackets after the respective entry. Alternatively, theimages currently displayed in the compilation list can be copied straightto a CD/DVD or a memory stick without adding further images.The compilation list of the images contains the name of the patient,DOB, patient ID and the number of images to be exported. Single entriesare deleted by selecting them with the left mouse button and clicking onthe button „remove selected entries”. There is also an option to deletethe complete list („discard this compilation”).

The name of an export list is generated automatically and is assembled asfollows:

Figure 111. Compilation

Image selection

List of images tobe exported

Selection of thedriver (CD/DVD /memory stick)

Name of theexport listSelection of options when compiling a patient CD

NOTE

The viewing application remembers the last ten export listsso that these may be copied again later.

Contains images of 2 patients

Date of the last change



By clicking the button „use current compilation“, the active displayedcompilation list is used for export to the patient CD and/or USB stick.In the section „Please choose target and options“, there is the option toselect which Viewer should be burned on the target drive to view theimages. There is the choice between the Standard CD-Viewer (HTMLViewer) or the complete Professional Workstation (Java Viewer), whiche.g. also allows to perform measurements.If no Viewer is selected, the DICOM data is used.

To make the right selection it is important to know the followingadvantages and disadvantages of the two options.

Table 4. Comparison standard vs. professional Viewer

The programme automatically creates a list of all CD/DVD drives andconnected memory sticks. This is where the user may choose the targetdrive to which the images will be copied. The copying process is thenstarted by clicking on the appropriate button below the selected target.

When inserting a patient CD/DVD or USB in the drive, a list of patientsand the corresponding images appear on the patient CD that can beviewed with the selected Viewer.

FIGURE 112. Patient CD with the Professional Workstation - select patient withpreview images

Standard CD-Viewer Professional Workstation

- fast start of the Viewer - slower at start of the Viewer and when loading images

- CD creation takes more time - CD creation faster

- images are twice on the CD (DICOM, jpg), thus 20% more storage space per image

- the Viewer itself uses little storage space on the CD

- the Viewer uses about 50MB more storage space on the CD

- no measurements are possible - measurements are possible and are displayed

Preview images



Furthermore it is possible to „Anonymize/customize DICOM data“ thatshould be burned on a patient CD by selecting the checkbox. It isnecessary to select the relevant data to be burned on the CD/DVD or USBbeforehand.

When exporting the data on the chosen drive by clicking on the button„Export to CD“ or „Export to USB keydrive“, a new dialogue appears thatoffers to anonymize and customize the DICOM data.

For more information on anonymizing DICOM data, please seepage 131.

Search for archived images

By clicking on the button „search for archivedimages“ the patient administration dialogue appearswith all patients stored in the database. The selected

patient studies are displayed as preview images. It is also possible todisplay the information of the studies in a table.

Figure 113. Patient management with preview images

Sets the searchparameters

Preview imagesfor each studyof the patient

Selects the time frameof the listed entries

Sets the grid to displaythe selected images

List of all patients according to the selectedtime frame and the search parameters

Opens the patient CD orteleradiology dialogue

Loads or addsthe selectedimages in theviewer



Figure 114. Patient management with table view

Study preview - Overview of a patient‘s studies

By clicking on the button „study preview“, thecomplete list of images archived for the currentpatient is displayed as preview images or in a table.

There are various ways to load the images. The loaded images aredistributed automatically into the selected grids.

Study date Modality with which the imagesof the study were taken

Switch between the tableand the preview window

Studydescription



Figure 115. Study preview

Figure 116. Study preview - table view

Study description

Additionally selectedexaminations will beloaded to the alreadyopened image

Loads all examinations ofthe display

Only selected examina-tions will be loaded, allothers will be closed

Sorts the imagesaccording to date

Series description Information aboutthe modality

Selected image(with a left click)

Switches betweentable view andimage preview

Marks all imagesof this study

Number of series inthe examination

Description of theexamination

Selects images / seriesto be loaded



Daily visual check

The monitor and the settings of the graphics cardhave to fulfil a number of legal requirements if theyare diagnostic monitors.

This tool has been developed to facilitate logging and documentation ofthis daily test.If configured, a dialogue is shown whenever no visual check has beenconducted on a given day when starting dicomPACS®DX-R. The testcan be done immediately or later. If the test is to be conducted later, thedialogue keeps reappearing during the work with dicomPACS®DX-R.

Figure 117. Daily visual check

After the successful authentication and start of the daily visual check, thefollowing information dialogue is shown:

CAUTION

After a successful acceptance test, certain values have to bechecked by the operator at defined intervals. The accuratedisplay of greyscales has to be checked by sight at least oncea day.

Name of the tester

Starts the test

List of all completedvisual checks

Protocols may befiltered

Shows the images forthe test

Prints the list ofthe tests



Figure 118. Start the daily visual check

The test images for the visual check are displayed on the monitor afterclicking the button „Starts the visual check”. For the daily visual check, aso called SMPTE and an ISO test image are used. The relevant elementsfor each question are marked with a flashing white frame for a shorttime.

Figure 119. Dialogue box - daily visual check

The next dialogue displays the result of the daily visual check. The testresults for a specific period of time and a specific work station can beprinted as a report.

Starts the daily check Closes the dialogue withoutconducting the check

Back to the previous question

Question to be answered; the respective elementsmust be clearly recognisable on all monitors

Exits the dialogue and test image

Possibleanswer

Goes to the next question or result



Figure 120. Result of the daily visual check

DICOM Send

After a click on this button, the DICOM Senddialogue appears. The recipient can be selected andthe study will be sent to the specified recipient by

confirming the selection. Additionally, the image quality can be selectedwhich determines the size of the data transfer.

Result of thedaily visualcheck

Selects a daterange for testresults to bedisplayed

Prints thereport

Closes thedialogue

The test justfinished will beshown in bold

CAUTION

If the test result is „failed" and images are loaded in theviewer, a warning triangle is shown. It is possible to repeatthe test but if it fails again, the monitors are not suitable fordiagnostic and viewing purposes. The monitors must bechecked by an engineer and readjusted if necessary.



Figure 121. Teleradiology via DICOM Send

The same dialogue appears also in the lists view when clicking on the„Send“ button to send images and findings to a DICOM recipient, seepage 51.

Sending Emails

This tool allows to send encrypted Emails with DICOM images.Therefore, the recipient has to use the encryption tool GPG4Win.

In the Email dialogue it is possible to select the images to be sent andtheir format. Multiple image formats can be selected.

The image formats that should be shown in the dialogue can beconfigured in the corresponding configuration dialogue by clicking onthe screw wrench button. There it is possible to select or deselect thecheckboxes for the file formats. Clicking on the button „Save“ stores theselection.

Furthermore it is possible to select sending the data via a .zip file and toshow the attachment size when clicking on the according button.

The following options are selectable when emailing image data:

- export with overlays- export with annotations- anonymize/customize DICOM data

Selects theset of theimages forsending

Selects therecipient

Selects theimagequality

NOTE

If no encryption tool is used, there is a prompt when clickingon „Send“ to confirm the action.



The last selection of the options section is stored for the next use.

When the checkbox „anonymize/customize DICOM data“ has beenselected and it was clicked on the „Send“ button, a new dialogueappears that offers to anonymize and customize the DICOM data.

For more information on anonymizing DICOM data, please seepage 131.

FIGURE 122. Send an Email with images

The section to determine the recipient can be enlarged by holding theleft mouse button down and move the grey bar up or down if necessary.

New recipient Email can simply be added in the line „To:“ The buttons

offer to delete the text in the line or to add a line.

NOTE

The option anonymize/customize DICOM data can only beselected when the image format „DICOM“ is chosen.

Select the imagesto be sent

Options for sendingEmails

Select the image format

Determine the sender address

Determinethe recipient

Email messageEnlarge address selection



When clicking on the button „Address book“ a new dialogue appearsthat enables to search for already existing recipients or to add new ones.

FIGURE 123. Address book

If a new recipient has to be added to the address book, select theaccording button and the following dialogue appears.

FIGURE 124. Add a new user to the Address book

NOTE

The Email address is coloured black as soon the Email formatis typed in correctly.

Search bar

Opens thedialogue to entera new recipient

Listed recipientsfor the Emailfunction

Checkbox foradding newrecipient Emailaddressesautomatically

Management of the decryption keysSelect an encryption type

Enter the data of the recipient



After all recipient data are entered, the dialogue can be closed byselecting „Save“ and the new recipient is listed in the Address book.

Different templates for the Email text can be selected in the selection box„Templates“ if configured.

To create a new template click on the edit button next to the templatelist. A new window pops up in which the template can be configured. Toconfirm the changes simply click on the button „save template“. Thatopens a dialogue where you can enter a name for the template, which isto be confirmed by clicking on „Ok“. The name of the new template isautomatically listed in the list of Email templates.

Already existing templates can also be configured or deleted by clickingon the corresponding buttons.

FIGURE 125. Create Email template

Create a new connection

To establish a new connection to a recipient enter the user data, selectthe encryption type PGP and select „Request the public key“. A dialogueto determine the sender address and to configure the email appears.

Creates new template Saves template

Deletes template



FIGURE 126. Request the public key

The sender address can be entered manually or an selection can beconfigured by selecting the wrench icon. By doing so a dialogue appearsfor the configuration of email accounts.

If no database is defined, the Email tool is not working. In theconfiguration dialogue the option is given to use the image database asthe webshare database or to configure a new database.

FIGURE 127. Database configuration

Edit or select anEmail template

Enter the sender address Opens a configurationmenu for Email accounts

Selection of adatabase



Furthermore it is possible to set further Email accounts. The „O+RAccount“ is a standard account and cannot be deleted.

It is also possible to Enter further sender Email addresses.

FIGURE 128. Configuration of email accounts

By pressing „Add“ to determine a new Email account, a dialogue appearsto enter the SMPT address, the user and the password of the Emailaccount to use it for sending Emails.

FIGURE 129. Enter the access data of an Email account

If all data are entered send the Email and the recipient gets an email witha link to an installation guide to install the encryption tool Gpg4win(www.gpg4win.de).

This document, especially chapter 6 Installation of Gpg4win and chapter7.1 Creating an OpenPGP certificate of the document, guides throughthe installation process, the main parts of the configuration and thecreation of a public key.

Management of theEmail accounts

Add or remove senderaddress from the list

List of the senderaddresses

Enter a sender addressin this field



This key has to be sent to the sender by the recipient. If Outlook byMicrosoft is used for sending Emails, the application needs a restart.

The sender has to store this public key from the email via the addressbook to the according user.

Now the PGP encryption is active and the following Emails are protectedfrom access by unauthorised persons.

3.1.7.2. Anonymize/customize DICOM data

Anonymising data is important for the privacy of patients when e.g.image data is passed on for scientific work.

DICOM data can be anonymised with only a few clicks with the followingexport functions:

- export images

- patient CD

- sending Emails

Anonymising of DICOM data can be selected in the dialogues in thesection „Options“, if the images are exported in DICOM format.

dicomPACS®DX-R copies the DICOM files and replaces or removes alldata fields that are required according to the configurable profiles anddesired changes.

The checkbox „anonymize/customize DICOM data“ in the section„Options“ is only active when the DICOM image format is selected.

When the checkbox is selected, a new dialogue opens after clicking on„Start“. It facilitates the process of anonymising DICOM data.



FIGURE 130. Configuration of file name and image formats

Generally four example profiles are loaded in the anonymising dialogue,with which data can be anonymised or customised:

- Anonymous - only image specific information remain, e.g modality, size, etc.

- Delete personal information - all person specific information are deleted, e.g. names, birth of date, address, IDs, etc.

- Use random data - to alienate the data, random names, dates and IDs are used for random values

- HD diagnosis - is similar to „Anonymous“ but patient comments remain

Image selection

Selection of the targetfolder and file name

Selection of the imageformat

Option for the dataexport



FIGURE 131. Anonymising profiles

To customise the profiles use either the button:

- „Create new profile“ or - „Edit profile“

When clicking on “Create new profile“, the following dialogue appears,where the name of the profile and the corresponding tags can bedefined.

Selected profile

Switches between DICOM values and description

Deletes all configuredvalues

Applies all valuesexcept those that werenot configured

Deletes the text

Edits the values, also random values can be inserted - one time changes apply here independent from the profile that can be set

Opens/closes the selection field

NOTE

Please note that for all profiles only the tags apply that areavailable in the image.



FIGURE 132. Create new profile

After saving the information, the newly defined profile is automaticallyadded to the list of predefined profiles.

The selected profile that is highlighted in the profile list can be edited,when clicking on „Edit profile“.

FIGURE 133. Edit profile

For anonymising data, the following options are available:

- DICOM tags can be deleted

Insert profile name

Add/remove tags forthe profile

Profile that is edited

Add/remove tags forthe profile

Select action

Edit tags



- DICOM tags can manually be added or changed

- DICOM tag values can automatically be from other tags

- DICOM tag values (e.g. date, time, name) can be replacedby random values. If necessary, the random values for thenames can also be configured.

FIGURE 134. Edit random names

Thus, according to DICOM standard, personal data of a patient, thepractice or clinic will be anonymous.

However, dicomPACS®DX-R does not remove image-specificinformation, such as the resolution or greyscale.

The original images are copied the images to be anonymised are givennew UIDs.

All data content within the image is presented in a clear table format,that gives a complete control and overview at all times about what datais used.

Profiles can be deleted when they are highlighted in the profile list andwhen the button „Delete profile“ is clicked.

NOTE

If patient information are burned into the pixel, they cannotbe removed, like on ultrasound images that were capturedby video signal.

NOTE

All given profiles are just sample profiles. It is highlyrecommend to customise the profiles according to yourneeds.



3.1.7.3. Configuration dialogue of the management tools


The configuration of the tab „Daily visual check“ as well as „Databases“can only be executed by OR Technology.

Figure 135. Configuration of the management tools

The tab search for archived images allows to configure the selectedarchive for the corresponding tool in the management toolbox.

NOTE

Any changes that are made in the profile that was set applyto all DICOM data when this profile is used.

One time tag changes, actioned by individualising the valuesin the right column, are not saved in the profile but areexecuted on the currently loaded DICOM data.

Tags of the selectedimage are displayed

Login for technicalsupport

All configurationtabs of themanagement tools



The different study search options allow to select how the user wouldlike the Patient administration dialogue to be shown.

Figure 136. Search for archived images - configuration

In the tab print it is possible to configure new DICOM- and Windowsprinter or to delete existing ones. The user may also reject specialconfigurations by resetting the entries.

NOTE

It is advisable that only your software dealer makes anychanges to the configuration of the archive.

Currently selectedarchive

Selectable archives

Selectable optionseffecting the patientadministrationdialogue of thesearch for archivedimages tool



Figure 137. Print tool - configuration

The tab patient CD allows to configure the software to be used forburning CDs. The default setting using MakeCD offers the possibility toburn CDs without obtaining a third party license, like for Nero. The use ofNero may however be configured if the user has an active andcompatible Nero version 6.6 until Nero version 8 installed on the PC,when it was used before an update.

Figure 138. Patient CD - configuration

Opens theconfigurationdialogue ofthe printer tobe configured

Resets all printerconfiguration

Deletes printerconfiguration

Adds a printer

Burns CDswithoutthird partysoftwareprogrammes

Burns CDswithcompatibleNeroversions



In the tab export images, the user may configure the preferred exportformats and the export directory for the images.

Figure 139. Export images - configuration

The tab Practice stamp offers the configuration of the practice data,which can be displayed e.g. at the top of the printout of images as wellon the patient CD start screen.

Figure 140. Practice stamp - configuration

Selection ofthe exportformats ofthe images

Selection ofthe exportdirectory forthe images

Entries to beconfigured for thepractice stamp

Deletes entries

Adds new entries

Changes existing orenters new entriesSelects the font size

Selects the font

Selects thealignment


3.2 Extended tools -143-

Any changes that are applied to the practice data are immediatelydisplayed in the list of entries.

3.2. Extended tools

3.2.1. Tool area Filter / dynamic

Figure 141. Filter / dynamic

In the configuration dialogue, the user may define keyboard shortcutsfor accessing the filter/dynamic tools.

CAUTION

To use extended tools, which are optional tools, togetherwith a virtual keyboard it is necessary to connect a mouse tothe PC to adjust the window leveling.


-144- 3.2 Extended tools

The display of images can be adjusted with filters in order to see furtheror new details to support the diagnosis and findings process. The imagedata is processed by the filters (e.g. grey scales), which means that theimage shown is not an exact reproduction of the original image data.

3.2.1.1. Tools of filter/dynamic

Filter

There are two types of filter: the so called magnifying glass with filterand the standard filter.The magnifying glass with filter is a combination of the magnifying glassand a filter. It combines the selected filter with the zoom factor set forthe magnifying glass and can be moved across the image.

Figure 142. Magnifying glass with filter

NOTE

The original data (raw data) of an image is never changed.Images that have been edited and are not displayed in theiroriginal state are marked with a warning symbol. Thewarning symbol is indicated with the following filters:sharpness filter, blurring filter, LUT (Look Up Table), relief filterand low pass filter.



The actual standard filter isalways applied to the entireactive image and may beswitched on and off. A slidecontrol is provided to adjust thestrength of the filter.

If the slider control is active,the filter enlarges bymoving the mouse over theslider

Shows the filter strength



Table 5. Available types of filter

Icon Functionality

Sharpness filter

Blurring filter

Activates a LUT (Look Up Table)

Relief filter

Low pass filter

Inverts the image

Auto level inside the magnifying glass

Histogram equalisation inside the magnifying glass



Dynamics

This area enables to change the grey scales of an image. The windowwidth of the grey scale range and the position of the window (windowcentre) within the range of the grey scales contained in the image maybe adjusted. The overall brightness of the image (gamma graph) can bechanged as well.

Figure 143. Dynamics

3.2.1.2. Configuration dialogue of filter /dynamic

Select the screw wrench icon to display the configuration dialogue.The configuration dialogue of the filter and the filter inside themagnifying glass are identical but the magnifier tab is only

available for the filter inside the magnifying glass.

In this configuration dialogue it is possible to change existing, add newfilters and to delete existing filters.

Adjusts the window width

Adjusts the brightness of the image

Shows the filter strength

Moves the window center

NOTE

The configuration of the settings on the Colour LUT and theMonitor LUT tab may only be executed by your softwaredealer.



Figure 144. Filter configuration

To create a new filter, first select the „new filter“ icon and select the typeof the new filter. Then enter the name of the filter in the text field. Thenew filter can be added to the section list for filters by clicking on the„plus“ button. A ticked entry is removed from the list of the filters by aclick on the „minus“ button. The selection list displays all available filterof the selected filter type. By a left mouse click on an entry, a filter can beselected and the appropriate filter matrix can be processed. For thefilters, either a 3x3 or a 5x5 filter matrix can be used. The filter matrix ofeach filter can be adjusted as preferred by simply changing the matrixvalues. In the dialogue below, a loaded image‘s histogram can be viewed.

Figure 145. Image histogram configuration

To provide and add new LUTs and to revise or delete existings LUTs thebelow configuration dialogue is used.

Provides a new filter

Adds/deletes a filter

Selection list of thefilter

Selects a filter matrix

Choice of using the standard filter only oralso within the magnifying glass

Selection of thefilter type

Processes thefilter matrix

Histogram of theloaded image



Figure 146. Configuration of the LUT

The below window is only displayed in the configuration dialogue of thefilter inside the magnifying glass.

Figure 147. Configuration of the magnifier

Provides a new LUT

Adds /deletes a LUT

Selection list of theLUTs

Aligns the filtergraph

Drawing on the filtergraph

Use of the LUT as a filter or alsowithin the magnifying glass

Sets the size of themagnifying glass inpixel

The value ofmagnification can beedited with valuesbetween 1 and 5

The help text can bedeactivated



3.2.2. Stitching

Figure 148. Stitching

In the configuration dialogue, the user maydefine keyboard shortcuts for accessing thedifferent stitching steps. By means of thestitching function, separate X-ray imagescan be stitched together easily to producean overall image. The images are uploaded,aligned correctly and can be joinedhorizontally or vertically to make oneimage. This function is ideally suited tocreate images of an entire leg or a completespine. The user simply has to select thedifferent images, cut at a marking point,align them and then save them as a newimage. The patient data from the loaded X-ray images is automatically assimilated.

Figure 149. Stitching applied

CAUTION

The stitching tools have been developed exclusively for thestitching function and must only be applied with imagescreated for that purpose.



To work with the stitching tool, first of all it isnecessary to select the according images to bestitched by pressing the button „Create Stitching

Image“. A new dialogue box opens where all images of the study aredisplayed and can be selected.

Figure 150. Image selection for stitching

The images can be selected in any order. The selection is indicated bynumbers displayed in the preview images. Any number of images can beused for selection.

Images from the study

Chooses the direction of stitching (vertical / horizontal)

Selected images

Note for pixel spacing

Selection toequalise thepixel spacing



To select the direction of stitching, it isnecessary to know that it can be chosenbetween a vertical or a horizontal direction.If there are conflicts between the imagesand their pixel spacing, a message will popup and it is possible to equalise the imagesby choosing the required values. Afterclicking on the button „Execute“ the imagesare displayed in the viewer in the set orderand orientation. To get a good detail viewzoom into the image by rotating the mousewheel with the cursor pointing on thepreview image on the right hand side. Theimages must then be cut at a marking pointto put them together that they form aunified image. By holding down the leftmouse button, the images can be movedeasily. The overlapping boundaries of thesub-images can also be changed by holdingdown the left mouse button. By clicking on finish stitching image adialogue box opens with a preview of thefinal composite image. Selecting „Continue“ allows to work on and tomake further changes. By clicking on „Execute“ the stitched image isadded to the study. All original images that were used for the stitching,will remain. To cancel the procedure, the Cancel button has to bepressed after which the dialogue box closes.

The tool „Move Images“ is activated by default. Byusing this tool, the images can be slid over eachother to the correct cutting edge.

„Cut Images“ is a tool for cutting overlapped areasof the sub-images. The processed sub-image ishighlighted by a neon green colour. In the process

the areas will only be faded out and not cropped. The original image sizecan be restored at any time using this tool. With the yellow arrows onthe right side of the stitched image it is also possible to cut the overlap.

Figure 151. Export stitching



The tool „Displayboundaries ofoverlapping areas“

is also activated by default. This toolprovides the display of the overlappedareas of the stitched images, which aremarked by yellow arrows at the edge ofthe images.

This tool allows to export the final image into anormal DICOM image which can be processed andedited. After pressing on the button „finish

stitching image“, the final image will be post-processed and afterwards adialogue will appear presenting the image. It can then be decidedwhether the result fits the expectations. It is possible to export or cancelthe operation to make additional changes to the image. The finishedstitching image is added to the study and is listed in the navigation bar.

This tool offers the possibility to remove asubimage from stitching by a left-click on it, e.g. incase the user has selected too many subimages.

The tool „(de-)activate flickermode“ allows tocompare the position of the images to each other.The overlapping areas are displayed like a flicker.

The flicker mode can be configured to a rolling mode below the image.One image rolls above the other. The speed can be set for both options.

Figure 152. Display boundaries ofoverlapping areas

CAUTION

The functionality of „Delete Subimage“ is not reversible.


-154- 3.3 The working area

3.3. The working area

The working area is used to display the loaded images. Additionalinformation on the images, such as patient name, date of birth andexamination details may be shown (see tool „annotations on/off” onpage 81). The tools and settings from the toolbar always apply to the currentlyactive image. An image is activated by a mouse click on it or bypositioning the mouse cursor over it and turning the mouse wheel. A redframe around the image confirms its active status. A yellow number indicates a selected image and shows the image’sposition within all currently selected images.

Figure 153. Working area of the viewer

3.3.1. Mouse button functions

Functions for the left mouse button:• Moves image within its grid area (PAN tool) by holding down themouse button

• Applies the tool selected from the tool bar (e.g. measurement,magnifying glass, annotation, etc.)

Functions for the right mouse button:• Applies the tool allocated to the button (e.g. window level,magnifying glass, etc.)

• Zoom: press the right mouse button and turn the mouse wheel

Working area


3.3 The working area -155-

Functions for the mouse wheel:•Zoom: press the Ctrl-key and turn the mouse wheel at the sametime or press the right mouse button and turn the mouse wheel

•Quick access menu: this menu appears by pressing the mousewheel.

3.3.2. Quick access menu

It is possible to set an individual favourites menu with the middle mousewheel. The user can press the middle mouse button to open a menu thatallows fast access to a freely configurable selection of tools.

Figure 154. Quick access menu

If the use of the middle mouse button is not desired or not available, it ispossible to uncheck the checkbox „open the quick access menu with themiddle mouse button“ in the configuration dialogue of the toolboximage selection in the viewer, see page 99.

By clicking on the screw wrench button on the left of the quick accessmenu the following configuration dialogue appears.

Opens the configuration dialogue ofthe quick access menu

Selection of tools and annotations

NOTE

Please note that this tool is not available for touch screen operation.


-156- 3.3 The working area

Figure 155. Configuration of the quick access menu

The favourites menu may also be assigned to the right mouse button viathe tool „tool for the right mouse button“ in the toolbox image selectionin the viewer, see page 99.

3.3.3. Full screen display

The full screen display is possible in the viewer. By using the key F11 onthe keyboard, the user can make the preview bar visible or not. The keyF12 makes the toolbar visible or invisible. The function is also located inthe quick access menu, which appears by a click on the mouse wheel,see page 151.

Figure 156. Full screen mode

Removes entriesby a click withthe left mousebutton

All tools arelisted accordingto the viewertoolbar

Adds entries tothe quickaccess menuby a click withthe left mousebutton


3.4 The navigation bar -157-

3.4. The navigation bar

In the navigation bar, all loaded images, series or documents are shownas preview images. With a mouse click on a preview image, the image isshown in the working area. If the working area is already divided by agrid, e.g. A1 – A4, the navigation bar will show a pop-up window wherethe grid area can be selected in which the respective image should bedisplayed. Images can be arranged within the grid in the way the userwishes. The option „Start relocating series into matrix from here“ offers theopportunity to distribute the images automatically from the navigationbar into the grid area by the shown order. When many images have been loaded, the visible part of the navigationbar may be moved using the scroll bar or the mouse wheel. The activated pick-up tool can be used inside the working area and tothe preview images of the navigation bar. All marked images are available for further use, e.g. for printing, export,creation of a patient CD or similar.

Figure 157. Navigation bar

Selection of the grid area intowhich the image is to be loaded

Study information

Marked image in a study

Scroll bar


-158- 3.5 The information bar

3.5. The information bar

The information bar provides the patient data for the currently loadedimages and the total size of all marked images. The total size can befound on the right of the information bar. This information is given inMega Bytes and helps to estimate the amount of data to be exported toa CD or similar.

Figure 158. Information bar

The RAM state on the left of the information bar can be configured byyour software dealer. A double click with the left mouse button reducesthe RAM usage for a short time to load memory intensive images. It alsogives an information when the memory capacity is low.

The small icon with the calendar and the arrow next to the RAM display,allows to sort more than one studies according to their time of exposure.

The free RAMmemory is displayed

Patient informationDisplays selected imagesand the size of the images

Sorts the studies

NOTE

The RAM status can be faded out in the support mode by atechnician.


4.1 Conformance statement -159-

Chapter 4.Appendix

4.1. Conformance statement

STANDARDS COMPILIANCE CERTIFICATE

CONFORMANCE STATEMENT Product, description dicomPACS® DX-R Version 2.3 Product, classification Class II b equipment Product, number SW 1000 Manufacturer Oehm und Rehbein GmbH (also known as OR-Technology)

Neptunallee 7 C 18057 Rostock Germany Phone: +49 381 36600500 Fax : +49 381 36600555 Email : [email protected]

We confirm that safety and effectiveness have been achieved in design and manufacture of the software mentioned above according to the requirements of the following international and/or national standards. The product described above conforms to the demands of Council Directive 93/42/EEC concerning medical devices. We also confirm that the software will be safe and effective when installed and uses in accordance with provided instructions by suitably qualified personal. The standards, as applicable to the above-mentioned software, are listed on the following page.

Rostock, May 7, 2012

Mr. Ragnar Rehbein (Managing Director)


-160- 4.1 Conformance statement

The medical device, specified hereafter, meets the provisions of the following standards: Name Description DIN EN ISO 13485 Quality management systems � Medical devices �

System requirements for regulatory purposes � German version

EN 980

Graphical symbols for use in the labeling of medical devices � German version

DIN EN 1041 Supply of information by the manufacturer of a medicine product � German version

DIN 6827-5 Recording in medical application of ionizing radiation - Part 5: Radiological report � German version

DIN 6878-1 Digital archiving of pictures in the medical Radiology - part 1: General requirements for the digital archiving of pictures � German version

CAN/CSA-ISO 14971

Medical devices � Application of risk management to medical devices � German version

IEC 60601-1 Medical electrical equipment � Part 1: General requirements for basic safety and essential performance � German version

CAN/CSA C22.2 NO 60601-1

Medical electrical equipment � Part 1: General requirements for basic safety and essential performance � German version

DIN EN 60601-1-4 Medical electrical equipment - Part 1-4: General requirements for safety - Collateral Standard: Programmable electrical medical systems � German version

DIN EN 60601-1-6 Medical electrical equipment - Part 1-6: General requirements for safety � Collateral standard: Usability � German version

DIN EN 62304 Medical device software � Software life-cycle processes � German version

DIN EN 62494-1 Medical electrical equipment - Exposure index of digital X-ray imaging systems - Part 1: Definitions and requirements for general radiography � German version

It has been designed according to EN ISO 13485:2003 + AC:2007 and CMDCAS ISO 13485:2003.


4.2 CE Certificate -161-

4.2. CE Certificate


-162- 4.2 CE Certificate

FDA Certificate


4.3 Quality Management -163-

4.3. Quality Management

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-164- 4.4 CMDCAS certificate

4.4. CMDCAS certificate

18057GERMANYROSTOCKNEPTUNALLEE 7 C

NNo d'homologation:87223Licence Number:

Première date de délivrance:2011/09/20First Issue Date:

Application Number: Numéro de la demande: 185896 133777Manufacturer ID:

Identificateur du fabricant:

La présente homologation est délivrée en vertu de l'article 36 du Règlement sur les instruments médicaux pour l'instrument médical suivant:

This Licence is issued in accordance with the Medical Devices Regulations, Section 36, for the following medical device:

Device Class/Classe de l'instrument: 2

DICOMPACS

Licence Name/Nom de l'homologation:

System / Système

Licence Type/Type d'homologation:

Manufacturer Name & Address/Nom du fabricant & adresse

OEHM UND REHBEIN GMBH

Therapeutic Products Directorate Medical Devices Bureau Direction des produits thérapeutiques Bureau des matériels médicaux

87223LN/NH:Santé Health Canada Canada

HHomologation d'un instrument médicalMedical Device Licence


4.4 CMDCAS certificate -165-

Chapter 5.Notes

Space for notes

Documents

dicomPACS®DX-R Acquisition Software User Manual