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iSite 3.5: Hanging Protocols I

iSite 3.5: Hanging Protocols I. Table of Contents. Objectives Terminology Introduction Hanging Protocol Hierarchy Presentation States Hanging Protocol Configuration Additional Information. Learning Objectives . Understand the purpose and configuration of:. Hanging Protocols

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iSite 3.5: Hanging Protocols I

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  1. iSite 3.5: Hanging Protocols I

  2. Table of Contents • Objectives • Terminology • Introduction • Hanging Protocol Hierarchy • Presentation States • Hanging Protocol Configuration • Additional Information

  3. Learning Objectives Understand the purpose and configuration of: • Hanging Protocols • Hanging Protocol Hierarchy • Presentation States

  4. Terminology • PACS (Picture Archive and Communications System) • Information Systems designed to manage, store and distribute medical images and related information throughout the healthcare enterprise • HIS (Hospital Information System) • Information Systems designed to manage patient records, including patient registration, billing, order entry • RIS (Radiology Information System) • Information Systems designed to manage exams (orders), including filling orders and scheduling

  5. Terminology • MRN (Medical Record Number) • A unique patient identifier (also known as Patient ID) used for auditing of billing and scheduling for patients • Accession Number (ACCession Number) • A unique exam identifier (also known as an order number or requisition number) used for auditing of billing and scheduling of scheduled procedures • SUID (Study Instance Unique IDentifier) • A unique study identifier used for auditing of performed imaging service requests

  6. Terminology • DICOM (Digital Imaging COmmunication in Medicine) • DICOM is the predominant communication standard between imaging equipment throughout the Healthcare Enterprise • HL7 (Health Level 7) • HL7 is the predominant messaging standard for exchanging key sets of administrative and clinical data in the healthcare enterprise

  7. Introduction

  8. Introduction • iSite Radiology Hanging Protocols are an important part of an efficient reading workflow • iSite Radiology has User and System Level Hanging Protocols • All iSite Radiology users will be able to select and utilize any User and System Level Hanging Protocols that have been created • Hanging Protocols may be configured according to User Preferences for viewing exams on the Diagnostic Monitors based upon Modality Type, Modality Type and Body Part, and Hanging Protocol Groups

  9. Introduction • User Hanging Protocols are created by and assigned to an individual user log-in, and are only available to the user log-in for which the Hanging Protocol was created • In order to create, edit or delete User Hanging Protocols the user must be assigned to an Access Group that has the Security Code ISTUSRHP enabled

  10. Introduction • System Hanging Protocols are created by the iSite Administration team and are available to all users • In order to create, edit or delete System Hanging Protocols the user must be assigned to an Access Group that has the Security Code ISTSYSHP enabled

  11. Introduction • iSite Radiology offers the ability to create multiple Hanging Protocols for the same Exam Type • Both User and System Hanging Protocols can be defined as Default Hanging Protocols or Alternate Hanging Protocols • There can only be one User or System Default Hanging Protocol for each Identifier key • There can be up to ten User or System Alternate Hanging Protocols for each Hanging Protocol Identifier key • For example: A Radiologist who primarily reads CR EXAM exams may want to define a few alternate Hanging Protocols to switch to instead of re-hanging the entire exam

  12. Hanging Protocol Hierarchy

  13. Hanging Protocol Hierarchy • iSite Radiology Hanging Protocols may be created with varying levels of specificity based upon values associated with each individual Exam Code in the Exam Code Dictionary, including the following:

  14. Hanging Protocol Hierarchy • This configuration level is specified in the Hanging Protocol Wizard

  15. Hanging Protocol Hierarchy • User and System Default Hanging Protocols are identified in the popup menu as ‘default’

  16. Hanging Protocol Hierarchy • User and System Alternate Hanging Protocols are never automatically applied to the Main Exam when loaded in the Canvas Page • Alternate Hanging Protocols are not identified in the popup menu as ‘alternate’ Hanging Protocols • However, Alternate User and System Hanging Protocols can be selected from the popup menu and are applied to an exam on the fly

  17. Hanging Protocol Hierarchy • iSite Radiology applies the highest ranked Hanging Protocol available for a given exam • The system will automatically select the most specific Hanging Protocol to load the Main Exam based on the exam Hanging Protocol Identifier Key • If both User Default User Hanging Protocol and System Default Hanging Protocol are defined for the same Hanging Protocol identifier key, the Main Exam will be loaded with the User Default Hanging Protocol

  18. Hanging Protocol Hierarchy • If only the Default System Hanging Protocol is defined for the same Hanging Protocol Identifier key, the Main Exam will be loaded with that Default System Hanging Protocol • If no User Default Hanging Protocol or System Default Hanging Protocol is defined, the Main Exam will be loaded with the Default hard-coded Hanging Protocol

  19. Hanging Protocol Hierarchy • The Main Exam is loaded in the Canvas Page with the Hanging Protocol automatically applied in the following order and hierarchy: • User Default ‘Hanging Protocol Group’ Hanging Protocol. This is the highest ranked Hanging Protocol. If defined for the Main Exam, this will be automatically applied. Otherwise, the System Default Hanging Protocol Group will be applied, if configured. • System Default ‘Hanging Protocol Group’ Hanging Protocol is automatically applied if no User Default ‘Hanging Protocol Group’ is defined for this exam. • User Default ‘Modality and Body Part’ Hanging Protocol. If defined for the Main Exam, this will be automatically applied. Otherwise, the System Default ‘Modality and Body Part’ Hanging Protocol will be applied, if defined.

  20. Hanging Protocol Hierarchy • System Default ‘Modality and Body Part’ Hanging Protocol is automatically applied if no User Default ‘Modality and Body Part’ Hanging Protocol is defined for this exam. • User Default ‘Modality’ Hanging Protocol. If defined for the Main Exam, this will be automatically applied. Otherwise, the System Default ‘Modality’ Hanging Protocol will be applied, if defined. • System Default ‘Modality’ Hanging Protocol is automatically applied if no User Default ‘Modality’ Hanging Protocol is defined for this exam. • Default Hard-Coded Hanging Protocol. If no User Default or System Default Hanging Protocols are defined, the Main Exam is loaded with a Default hard-coded Hanging Protocol.

  21. Presentation States

  22. Presentation States • Presentation States over-ride Hanging Protocols • When the user opens an exam, the Presentation State with the highest priority will be presented • The most recent Presentation State for the highest priority Presentation State will be applied to the exam

  23. Presentation States Hierarchy • “Mark Read” Presentation State is the highest priority Presentation State. If a “Mark Read” Presentation State has been defined this will automatically be applied. • “Pre-Read” Presentation State is the second highest priority Presentation State. The “Pre-Read” Presentation State enables a radiologist to save image presentation modifications without requiring the exam be “Mark Read”, so the radiologist may later return to the exam. • “Technologist” Presentation State enables the radiologic technologist to modify image presentation prior to the radiologist viewing and interpreting the exam. • “Original DICOM” Image Presentation is automatically applied if no Presentation States have been defined for this exam. • “User” Presentation State enables specialists to modify image presentation prior to and following radiologist interpretation without effecting other users.

  24. Presentation States • When the user selects a Presentation State any modifications based upon the following features are displayed: • Window Width and Window Level • Measurements, excluding Point Value • Annotations • Invert Image • Key Image • Clone • Key Images • Flip • Rotate • Sort • Split

  25. Delete Presentation State

  26. Hanging Protocol Configuration

  27. Hanging Protocol Configuration • Hanging Protocol configuration is specified in the Hanging Protocol Wizard found in the pop up menu in the Shelf Bar of the Exam Rack

  28. Create User Hanging Protocol • The ‘Use Current Exam Layout’ option allows the ability to auto-populate the Hanging Protocol Dialog (WYSIWYG concept) when the Hanging Protocol is edited by the user • The ‘Use Current Exam Layout’ option is only available if Series Matching Rules have been defined

  29. Create User Hanging Protocol • ‘Series Matching Rules’ are created and configured by the site PACS System Administrator • To create Series Matching Rules, the user must be assigned to an Access Group with the Security Code ISTHPSTD

  30. Hanging Protocols Configuration • Page Two of the Hanging Protocol Wizard displays the following configuration options: • Multi-Image Mode • Window/Level Preset • Scout Lines • Show Localizer • Invert Image • Clones

  31. Hanging Protocols Configuration • To configure the Display settings that will be applied to all Stacked Image Windows, click on the ‘Stack Window(s)’listing in the Series list control, then select the desired settings • All options are available for Single Image Window(s) and Stack Window(s) with the exception of ‘Multi Image Mode’ • ‘Multi Image Mode’ options are only available for Stack Windows

  32. Hanging Protocols Configuration • To configure the Display settings that will be applied to all Single Image Windows, click on the ‘Single Image Window(s)’ listing in the Series window, then select the desired settings • To configure the Display settings for Clones, select each clone and make your selections

  33. Hanging Protocols Configuration • Series Matching Rules are sub-features of Hanging Protocols • The advantage of using Series Matching Rules as part of Hanging Protocols is: • Automatic sorting of series • Automatic application of features to specific series • Multi-Image Mode • Window Width/Level Presets • Scout Mode • Localizer Mode • Image Invert • Clones

  34. Hanging Protocols Configuration • ‘Add Clone’ and ‘Remove Clone’ options are available for ‘Stack Window(s),’ ‘Single Window(s)’ and ‘Matching Series’ series options • iSite Radiology provides the ability to create and configure clone settings automatically as part of a Hanging Protocol • In the Series list control, clones can be created and removed for ‘Stack Window(s)’ and ‘Single Window(s)’ • Up to 6 clones can be created for each series option

  35. Hanging Protocols Configuration • Multi Image Mode allows you to display stack image windows in Multi-Image modes in the diagnostic monitor • This option is not available for single images

  36. Hanging Protocols Configuration • Default Window/Level: Hanging Protocols support applying the default Window Width/Window Level to the Stack, Single Image Windows or Matching Series • If the checkbox ‘Default Window/Level’ is selected, the User and System Default Window Width and Level are applied to the selected Stack, Single Image Windows or Matching Series • Window/Level Preset: The Window Width/Level Presets allow applying quickly a specific Window Width/Level in order to view particular anatomy

  37. Hanging Protocols Configuration • Additional presets are displayed, if configured • Presets may be configured for all modality images • Important Notes: • Configured User and System Presets will be merged under Window/Level Presets list control • If both User and System Window Width/Level Presets are configured for the same modality image and have the same Preset Name, then User Window Width/Level Presets/ Value takes precedence and User Presets will be displayed

  38. Localizer, Scout Lines and Invert Image • Show Localizer: This option allows the display of Localizer tool on images. When selected, images will display the localizer on all images from the same frame of reference with the image selected. Localizer is displayed only on MR, CT and PT series. • Show Scout Lines: This option allows the automatic display of scout lines on single images or on stack series. Scout lines are displayed only on MR, CT and PT series. • Invert Image: This feature is only available for grayscale images. When this option is selected for a Single or Stack Series, the images will be displayed in ‘Invert’ mode.

  39. Monitor Control • Page Three of the Hanging Protocol wizard opens with the Monitor Control group box • In this Hanging Protocol Wizard Page, the available ‘Matching Series’ are listed in the ‘Matching Series’ list control, whereas the rack series are listed under the ‘Other Series’list control

  40. Matching Series • Under ‘Series Matching’ list control, there are two buttons ‘Move Up’ and ‘Move Down’ • These are used to change the matching series order to place them on a specific monitor • When a matching series is selected and ‘Move Up’ or ‘Move Down’ are clicked onthe matching series will be moved up or down on a specific pane in Monitor 1 or Monitor 2

  41. Monitor Control • Monitor Mode options can be selected for Diagnostic Monitor 1 and 2: • Monitor 1 Mode • Monitor 2 Mode • In this window, the diagnostic monitor mode selection can be previewed for Monitor 1 and Monitor 2

  42. Monitor Control • Hanging Protocol Monitor 1 Mode and Monitor 2 Mode layouts are: M1, M2H, M2V, M3H, M3V, M4, M6P, M6L, M1_2, M2_1, M1_3, M3_1 • Important Note: the monitor configuration loading differs on one-monitor systems, two-monitor systems and four-monitor systems

  43. Main Exam Options • Page four of the Hanging Protocol Wizard opens with the following options available only for the Main Exam configuration: • Linking • Load Relevant Prior based on Matching • Number of Priors to Load • Cache Entire Study • Spine Label Tool on Sagittal • Split Mode (if enabled)

  44. Linking Options • The following are the available Linking options: • Link All Axials • Link All Sagittals • Link All Coronals • Link All Obliques • Set the Linking options as desired • You may link all axial, sagittal, coronal or oblique views of the Main Exam

  45. Relevant Prior Loading • The ‘Load Relevant Prior Based on Matching’ can be configured to be loaded based on ‘Body Part Only’ or on both ‘Modality and Body Part’ matching • The ‘Body Part Only’ option loads the relevant priors in the Relevant Exam Timeline and the Exam Rack based on matching of the same Body Part • For example: Body Part CHEST

  46. Relevant Prior Loading • The ‘Modality and Body Part’ option loads the relevant priors in the Relevant Exam Timeline and the Exam Rack based on matching of the same Modality and Body Part • For example: Modality CR and Body Part CHEST

  47. Hanging Protocols Configuration • The ‘Number of Priors to Load’ option allows up to 10 Relevant Priors to be loaded automatically in the Hanging Protocol Wizard • The ‘Cache Entire Study’ option allows caching of the entire Main Exam into iSite Radiology workstation memory • If the ‘Show Spine Label Tool on Sagittal’ box is checked, the Spine Label Tool will be displayed on all Sagittal windows

  48. Additional Information

  49. ‘F2’ Hotkey • iSite Radiology is designed to work with one, two or four diagnostic monitor displays • However, iSite Radiology only supports the configuration of two-monitor Hanging Protocols • Only two monitors can be configured (i.e. Monitor 1 and Monitor 2) in the Hanging Protocol Wizard

  50. ‘F2’ Hotkey • The hotkey ‘F2’ is designed to toggle between what is visible (i.e. Monitor 1) and what might not be visible (i.e. Monitor 2) on a two-monitor system configuration • On a one-monitor system, the F2 key toggles between the first and second series • Monitor 2 is considered virtual monitor on a two-monitor system • On a four-monitor system, F2 key does not have any functionality

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