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IntelliSpace PACS 4.4
Image Enabled EMR Workflow and Enterprise Overview
Learning Objectives
• Image Launch Workflow (SUBI Image Viewer)
• View Images
• View Reports
Use the Cerner EMR to view images and reports via IntelliSpace PACS:
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IntelliSpace PACS Enterprise
• Web-based medical image distribution solution that delivers diagnostic-quality images to clinicians anytime, any place in the healthcare environment
• Used by: Clinicians (Referring Physicians, Nurses, Surgeons, Techs)
• For: viewing, analyzing, qualify images
EMR Image Launch Workflow
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Cerner EMR: Results PageStep One: Select Radiology Results
Cerner EMR: Results PageStep Two: Select Report/Results that you would like to view
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Cerner EMR: Results PageStep Three: The Report Will Display
Cerner EMR: Results PageStep Four: Select the View Image Icon to launch the study for viewing
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Cerner EMR: Results PageStep Five: the SUBI Image Viewer will launch
If the image button is not enabled in PowerChart, You can also launch the SUBI Image viewer from Citrix.
Cerner EMR: Results PageStep Six: the exam will open for viewing
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Viewing Images
Canvas Page
1. Patient Information Area:Patient’s name, DOB, sex, MRN, Referring Physician and Patient Class
2. Patient Timeline: History of and navigation menu to all of a patient’s studies in IntelliSpace PACS
3. Exam notes: When icon is present, indicates diagnostic report is available for the exam. Click to open the diagnostic report.
4. Exam Margin: Access point to exam specific menu and information
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Canvas Page (continued)
5. Thumbnail: Thumbnail view of image
6. Exam Rack: Set of images that make up the exam
7. Image/ Series Information:Image specific information (for example; description, number of images, slice thickness, etc.)
8. Image/ Series date and time:Exam accession number, Date and Time image was acquired
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Patient History Timeline
• History of and navigation menu to patient’s exams in IntelliSpace PACS
• Colors and symbols in timeline
Hover mouse to view exam information
Green No diagnostic report
Blue Diagnostic report available
“ | ” Image available
“X” No images
“A” Exams on 3rd party digital archive—not on IntelliSpace PACS server
Left-click to open exam
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Patient History Timeline (continued)
Timeline Sub‐menu:
1. Open Exam: Open exam and return to main Patient Directory
2. Close Exam: Close exam and return to main Patient Directory
3. Show Report: View diagnostic report
Right-click for menu
Navigation within the Exam Rack
• Exam Rack: the set of images in an study
• Reorder series by dragging and dropping on grey image header or footer
• Navigating through stacked series
1. Mouse wheel
2. Select “C” on keyboard
3. Select Cine Loop from context menu
Double-click to open in pop-up window
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Screen Overlay
• Used to display the DICOM overlays on the image from the modalities
• Different Screen Overlays for each modality type
• F6 key toggles screen overlay on/off
Preparing Images
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Context MenuRight-click on series for context-menu
Single Image Series Menu Stacked Series Menu
Note: Additional menu items may be present depending upon API integrations and use of Philips Clinical Applications
Window Width/ Level• WW/WL menu
– Default WWL: Applies IntelliSpace PACS WWL values
– Modality default: Applies modality WWL values
– Histogram Calculation: Uses histogram calculation to set WWL
– Customer WW/L set by admin: Applies WWL values set by admin
• Changing Window Width and Level
– Mapped to 1‐10 keyboard number keys for CT (for example; 1=Abdominal)
– Mouse: While holding down Left button, move mouse horizontally/ vertically
– Image Menu
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Measurement
• Tools to measure specific areas of an image
• Measurement menu:– Ruler: Linear measurements (pixel or
mm)– Angle: Degree measurement for
specified region– ROI Circle: Average data value for a
circular region of an image– ROI Ellipse: Average data value for an
elliptical region – ROI Freehand: Similar to ROI but allows
free‐hand selection of ROI– Point Value: The value of data points at a
specific point on the image pixel– Measurement Palette: Floating
measurement palette– Calibrate Image: Calibrate to a certain
known measurement
Image Processing• Image enhancement tools
• Process images (excepted inverted) are marked with “P” icon in the lower right corner of image
• Image Processing settings are editable in User and System Preferences
• Image Processing menu:
– Invert Image: Reverses the black and white coloration of an image
– Edge Enhance: Increases image edge visibility
– Edge Detect: Uses Sobel operator to increase image edge visibility
– Median Filter: Common filtering method to reduce noise in the image
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Image Viewing Options
• Scout Line (series only): Reference line inserted to help visualize and navigate to same location in multiple series with different orientations (2D)
• Localizer (series only): crosshair (+) reference mark to help visualize and navigate to a location in multiple series with different orientations (3D)
• Create Pop‐up: Inserts selected series into floating pop‐up window
• Clone Window With Preset: Creates a copy of the selected series with a Window Width/Level preset
• Key Image: Marks specific images as notable in the study and puts it into Key Image window
• Play Cine Loop (stacked series only): Cycles through images in series in a continuous loop
Linking Options (Series Only)
• Synchronizes images or series with a designated “master” image to:
– View through multiple images at the same location simultaneously
– Have same “navigation” as the master, like Zoom or Pan
• Linked Series denoted by icon
• Link Sub‐menu:
– New Link: Link images within or across studies
– Link All Axials/ Sagittals/ Coronals/ Obliques (series only): Links all series in exam rack with the same orientation
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Save & Print Options• Window to Clipboard: Copies the entire window
withmeasurements, annotations, and overlays to the clipboard
• Window to File: Saves window as either a JPEG, TIFF, GIF, PNG or BMP format filewith measurements, annotations, and overlays to the clipboard
• Image to Clipboard: Saves only the images, without measurements, annotations and overlays
• Image to File: Saves images as either a JPEG, TIFF, GIF, PNG or BMP format file withoutmeasurements, annotations and overlays
Image Orientation and Sorting
• Flip:
– Horizontal: Right to left (x‐axis)
– Vertical: Top to bottom (y‐axis)
• Rotate: Clock‐wise, counter clock‐wise
– Rotate 90 CW:
– Rotate 90 CCW:
• Sort (series only)
– Image Number Ascending (1, 2, 3, etc.)
– Image Number Descending (3, 2, 1)
– Table Position Ascending
– Table Position Descending
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Zoom Presets• Zoom Presets: Used to apply a zoom
factor to a series
– Fit to Window: Adjusting zoom factor applied so that the entire image is visible on the screen
– True Size: Approximates the actual size of the anatomical structure on screen
– 100 % Original Size: Also known as pixel‐to‐pixel where a single pixel in the image corresponds to a single image on the screen
– 200%, 300%, and 400%: Additional zoom factor options
Key Image
• Key images stack must be enabled in User Preferences to be visible
• Images that are marked as key images are saved when a Presentation State is saved regardless of whether Key Image Window is enabled
• Images can be marked as key images by: – Pressing [Space Bar] when image is selected– Key Image option in context Menu
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Exam Margin
Right-click for Exam Margin menu
• Exam Margin: Grey bar to the left of the exam rack with additional exam menu and information
Closing the Image Viewer
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Closing Options
• There are two options to close out of the study or the viewer all together.
• Option #1: If you are completely done reviewing images/studies at this time, will want to close out of the image viewer window.
• Option #2: If you plan to review additional images/studies and results during your logged on session, you will want to use the radio button on the control strip to close just the study.
Closing Option #1: Closing Out of the Image Viewer
• Option #1: If you are completely done reviewing images/studies at this time, you will want to close out of the image viewer window.
• To do this, you will want to use the Windows red X at the top right hand corner of the SUBI Image Viewer window. This will totally close out the viewer.
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Closing Option #2: Closing Out of the Image Viewer
• Option #2: If you plan to review additional images/studies and results during your logged on session, you will want to use the radio button on the control strip to close just the study.
• To do this, you will want to use the radio button on the control strip. This will close just the open study.
Closing Option #2: Closing Out of the Image Viewer
• Closing the study via the radio button will still keep the SUBI Image Viewer window open and will allow for quicker study launching when reviewing additional cases.
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Closing Option #2: Closing Out of the Image Viewer
• If you close via the radio button, you will still see an open SUBI Image Viewer Window that looks like the below window.
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