USER MANUAL - Digitalix-dx
Contents
1. Comparison of the right side images 24 2 Two studies Please adapt and change those protocols according to your needs Current previous study all images Current previous study MLO images Current previous study CC images Current study all images right side Current study all images left side 25 9 9 GENERAL SETTINGS 9 9 1 INTERFACE SETTINGS Pr a oter om tte op ef tte erate Oman tite 0 Ge core temy gr Ha ATT TTS TJ Feet murty far oxtoruned rakrgusht ragdhusnn tater were co Ti vs fame Oula totter tat uting CUCM dreg ty sae afew Magia ty Rete ing Ve wiati erty Frem wu agree in Rent rg tte twe hette ma Q MAMMO OE ETTE i a GUI defines where and how the toolbar will be displayed at the top or the sides of the window with large icons and or font Twin presentation It is possible to have two toolbars and two thumbnail bars this is useful if you have a double monitor setting Other default magnification settings o Itis recommended to have the mouse point zoom always enabled 26 o Ifa magnification factor is set the DICOM tag Estimated Radiographic Magnification Factor 0018 1114 and its value will be ignored o The defined folder will be used to store DICOM Secondary Capture files Zooming by mouse wheel It is possible to define the direction of rotation for Zooming in and out 9 9 2 PRESENTATION SETTINGS2. Next previous reading step Switching to the next or previous hanging step As DX MAMMO has a deep interface with DX VIEW PRO some features in this drop down list are not needed and some are grayed out Al 3 Display Tool bar Thumbnail bar Statusbar bar Lookup tabie Magner window 1 Gr ale display Toolbar switching toolbar ON OFF Thumbnail bar switching Image preview bar ON OFF Status bar switching F key shortcuts bar ON OFF Lookup table opens a lookup table in a separate window Magnifier Window opens an additional window zoom up to 600 inversion possible Histogram instantly updated Scale display adds a scale on the bottom of each tile for easier reference 42 4 Presentation Tiling Possibility to choose between 7 different Screen Tiling options 1x1 2x1 4x1 2X2 4x2 2x2 2x1 2x1 2x2 Display Information switches different information ON OFF Annotation switches text annotation DICOM header ON OFF Overlay switches any overlay e g CAD ON OFF Presentation State switches any stored LUT ON OFF Shutter switches Shutter ON OFF CADSR switches CADSR ON OFF Measurements and figures switches measurements and circles ON OFF Black colorings outside the breast region switches the masks over all other information
3. visible on the image e g marker scriber ON OFF Maskings and blockers switches maskings and blocker ON OFF Overlay control Overlay control is disabled by default 43 Display the active image in a new window using this feature no measurements or blockers will be copied into the new window Flipping enables vertical flipping of the selected window or all windows all measurements and blockings will be kept Inverse enables inversion of the selected or all windows if the automatic image positioning is activated the breast area will be inverted and the surrounding area will stay dark Rotation rotates the selected image 90 degrees clockwise or counter clockwise Automatic image positioning reloads all tiles according to the current hanging step Additionally the one touch initialization features as selected in the General settings will be carried out please refer to chapter 9 9 5 for further information Close window unloads the selected or all windows tiles will stay blank until otherwise filled One touch initialization all features selected in the General settings will be carried out using this button please refer to the chapter 9 9 5 for further information Manual vertical positioning used to manually adjust the vertical alignment of the images Automatic vertical positioning automatically adjusts the vertical alignment of the image according to the nipple height position in the se
4. 0 MAMMO EE EEE Thumbnail list adds details to the thumbnail view Study List defines the amount of information shown in the patient study list for further information please refer to chapter 10 5 6 Symmetry defines which features should be carried out simultaneously for contra lateral image pairs 9 9 3 ANNOTATION SETTING i bad n IY iOMiMMO gt J o 27 a Presentation position defines View Position marker on the image Middle Marker Position Bird s Eye View preview icon outlining the current magnification positions and if box is chosen reflecting current Window level and inversion setting This feature is not available in the US o ol so o oa a mo oser ee hece l bia un o m om te Mnd 96 ues gt oe e Cimb Dan p s bhie gt an Pad Pab ba Cao an j n Com Annotation position and markers It is recommended to set the reversal annotation in the R lateral image to avoid text overlaying the images Reversal annotation in R lateral image 7 NO Reversal annotation Brightness and Magnification of the Annotation the Patient Name and the Patient ID can be set 28 9 9 4 READING CONDITION 1 te el ert Os Premremen state et eng ske vawr m tanten MN Heen Irene rest estere de net OG 4 ne ow 8 BEE 0 OD amp me trtar breie Come h terrible mnt meng el
5. EEE 26 9 9 2 Presentation settings rrrrnrrnnrrnnvrnnnrnnnernnernnnennnennnernnnennnennnennnnennnennnennnnennnennnennnnennnennnennnnennuennnennnnennnenen 27 MN 27 gd A ee AC i Condition EEE EE NE EN ER 29 Jakana 16 410 17 8 EE nr eR ne SEE ee 30 9 LO Additional Service Setting Secretin a E EE 31 9 10 1 Configuration settingg rrrrrrnnnnrrnnnrrnrnrnnnnrrnnnernrnernrnevnnnnennnnernrnevennsennnuenenueenrnennnnsnnnnenenneennssennnenennssene 31 DD NT 32 9 10 3 Drawing settings Configuring the ISD mode rrrrnrrnnnnrrnnnrrnrnernnnnrnnnnrrnnnernrnnvnnnnennnnsvennevnnnnvnnnnsnnnnenene 32 9 10 4 Additional Hanging Protocol settings uuansmidredemmanendniltdienibaniibeasmsmalieiivnstsertte 33 9 10 5 Mouse and keyboard settings rrrrrrrrnrrnnernnnrrnnernnnrnnnennnennnevennennnennnevnnnennnennnevnnnennuennnennnnennnennnennnnennnenen 34 9 10 6 Other settings rrrrnnrrnnrrnnnvrnnvrnnnrnnnennnernnernnnennnennnennnnennnennnennnnennnennnennnnennnenenennnnennnennnennnnennnenenenennenenenen 35 10 USE OF SOFTWARE APPLIC TIN Gave 36 VL AS vce cts ate serse a S E A EE EA A AA 36 10 1 1 Adding images to a current hanging e seessessessresrrssrrscrresreserrstestesrerstsstesteseessessteseeseessteseeserseerseeseesee 36 EOP Usine Haneme Pavens 37 10 3 Most commonly used features sessioissa r EE Ea RESNE SENi 38 10 4 Storing findings as DICOM SC rvrrnrrnnnrrnnnrrnnnrrnnnernnnnernnnernnnsvnnnnvnnnnennnnsnnrnsvennnennnnsnnnnsvennsvnnnusnnnn
6. It is possible to use the Logitech G600 Mouse As this mouse has an internal memory it is possible to pre configure the mouse before usage list with recommended settings for its 12 configurable thumb buttons you will find in chapter 12 2 Toolbar The toolbar is a very customizable tool giving fast access to a specified number of features For additional information please refer to chapter 9 5 and chapter 9 9 1 3 Right click Menus 8 different menus can be opened using a right mouse click into the viewer right click right click CNTRL right click ALT For additional information please refer to chapter 9 6 4 Shortcuts Another way of accessing a specific feature is to use shortcuts key combinations For additional information please refer to chapter 9 3 5 Zoom DX MAMMO has 6 different ways to zoom an image Define the Magnification factor within a HP chapter 9 8 1 Mouse wheel zoom chapter 9 9 1 Magnifier Window Cal opens an additional window zoom up to 600 inversion possible Histogram instantly updated chapter 10 5 2 3 38 Zoom button zooms on the mouse point chapter 10 5 2 5 Magnifier A overlays a magnifier lens on top of active window chapter 10 5 2 5 Smart Zoom zooms the image on the middle of free hand drawn circle clockwise when drawing a counter clockwise circle the image will
7. can be defined using the Text overlay setting see chapter 9 2 Laterality and View position are taken from the corresponding DICOM tags see chapter 9 7 Symmetry switches symmetry between contra lateral images ON OFF Scale will only be shown after activation in the Display menu of the top toolbar Zoom displays current Zoom in Windowing displays current windowing Monitor configuration activation of ISD feature see chapter 9 10 3 Page switch if no HP mode is used all loaded images can be displayed on different pages containing the same layout the arrows switch between those additional viewer pages 10 5 4 HANGING STEPS BAR FOR MG IMAGES This bar is located at the bottom left corner of the window and only visible if either of the hanging protocol modes 1 3 is activated In normal mode without using a hanging protocol this bar is not visible 52 It enables you to go forward or backward steps in your hanging sequence or to choose a specific step It also shows you the current step and its description epramnmene p NOTE A hanging protocol step containing no images e g left CC compared with left MLO after breast ablation left will be ignored using the forward back buttons 10 5 5 HANGING STEPS BAR FOR TOMOSYNTHESIS IMAGES This bar is located underneath the viewer window and only visible a Tomosynthesis series is loaded into the Viewer In case no Tomosynthesis study was detected th
8. currently loaded study o Set parameter of HP by every user the hanging ini will be stored in the personal folder path defined in the Configuration tab and will be called dependent on the Windows user log in Image Scale MG CR DR o Defines the Magnification of the images in each Tiling option if no Hanging Protocol has been chosen Normal protocol mode Fit magnification calculation picture magnification fit for image display frame x specified magnification 33 Scale magnification calculation specified magnification x 100 9 10 5 MOUSE AND KEYBOARD SETTINGS th ioc tate me Cotgssnr Monier Omeng anges Poteo Mew art fare Osen LET V Looe by OG G db SOG D Pen ty craggy eth mii oe fetter Mna v red oe gt gt me MEN tar au Meee ee 7 Doin oran cony mod Snor Ovnar tere v Seo ting Tette ert FOs GPO Ti enn Seg a keen omg st err righ virje 17 her FY DA W bier at hacer Sul ewer re treet Lae te OMe red a Date ty eg mnd we ee Gram tee vo Uvis Mouse Zoom by rotation with a mouse wheel Pan by dragging with a middle mouse button Mouse cursor sensitivity in Pixel Apply twin mirror mouse cursors an additional mouse cursor will appear on the contra lateral image Enable smart cursor mode o Smooth moving between multi monitors when moving the mouse cursor between different sized
9. double click on study or right click on study and choose Automatic image positioning or Drag and drop from Image Preview bar There are several ways to access a specific feature You can use one of the following options Menu bar or Toolbar or 3 different right mouse click MyMenu options right mouse click right mouse click and CNTRL right mouse click and ALT or Keyboard shortcut or F Key shortcut The following chapters describe the use of the different parts of the DX MAMMO Start page AO 10 5 2 MENU BAR The menu bar gives fast access to all features included in DX MAMMO Following is a description of the different drop down menus and their contents 1 File Open Open study from directory Open DICOMDIR Open study from DICOMDIR Save in DICOM format To safe findings as DICOM SC please refer to chapter 10 4 Safe in other formats Safe images as JPEG or BITMAP The following entries are not activated o Clipboards copy Copy image s to the clipboard for report system and Export image s to report system Exit to exit the whole application and shut it down As DX MAMMO has a deep interface with DX VIEW PRO some features in this drop down list are not needed and some are grayed out 2 Navigation Hanging Protocol switch between the different Hanging Protocols Protocol mode 1 2 or 3 or to deactivate them by going back to the Normal view
10. gt Weert orka Q MAMMO o f oe i In an application starting process defines active features during startup of the application Automatic image arrangement Automatic loading of images when no Hanging Protocol is chosen see chapter 9 9 5 for further information Overlay the CAD Overlay is automatically turn on after startup if available Presentation state the Look Up Table LUT is automatically turned on after startup if available Block coloring outside breast region after breast region detection the surrounding area will be filled in with black generating a sharper contrast and also overlapping any information imprinted in the image itself e g view position or laterality information Shutter attributes The shutter attribute included in the DICOM file will be applied One touch initialization all actions included in this process will be defined in chapter 9 9 5 this process can be started in 2 different ways o Automatic during the loading of images One touch initialization needs to be activated in the application startup process or o Manually with the One touch initialization button ot it will perform automatic vertical positioning black coloring outside breast region skin line detection adjustment of gamma value concentration tuning etc to the picture currently displayed on image display area Draw shutter lines helps identify the correct positioning of the shutters on opposing imag
11. monitors the position on the new monitor will be interpolated due to the relative position on the old monitor o X axis endless moving when moving the mouse cursor above the upper edge of the monitor display the mouse cursor will reappear on the lower edge of the monitor display and vice versa O Y axis endless moving when moving the mouse cursor out of the right side edge of the monitor display the mouse cursor will reappear on the left side edge of the monitor display and vice versa o Sensitivity High Middle Low of the mouse cursor Key Function Interrupt function study forward step forward Clear key buffers in command activation by pushing an assigned key o This feature prevents duplication of processing orders by unwilling continuous hits unto the keyboard 34 9 10 6 OTHER SETTINGS OD ea tr O Me Usiferwur Merve Omang Penge oorti Aine ent toy Ort Thuirt tet Orie ot hereto tt sts ETE EEE ha oo SALA MO PRO BOO KOLO Cote eter J Tome tress te rn met it edel Dipa inntas LSA t rt eta tamt ate hee Sed rg te ter w wate Om mrap ow tg lente FK MEDIO SYSTEM GE MEDIDA STON Des wren Me othe Thumbnail list o Order of a thumbnail list order of automatic image allocation Option Function activation of additional modules o Tomosynthesis please see chapter 5 4 Others o Only read object modality as defined if
12. return to the initial size the magnification becomes larger if the circle is drawn twice or three times in a row 10 4 STORING FINDINGS AS DICOM SC It is possible to store Annotations or changes in Windowing Zoom and Pan as a DICOM Secondary Capture To store Secondary Capture images back into DX VIEW please do the following a Click on Save in DICOM format and define to safe the selected window or all windows Presentation From the next window choose the following Level of information it should contain Original for no further information Image Annotation to include all Annotations or Capture including Annotation Zoom and Pan and press ok Secondary Capture as an SOP class Modality of your choice for this secondary capture image The Secondary Capture will be stored in the predefined location please refer to chapter 9 9 1 and can then be loaded by DX VIEW 39 10 5 TOOLS 10 5 1 STARTPAGE Menu boar Hanging Steps bar Sram Mia sp Study List View Position Image Preview bar meee F Key Shortcuts E Matrix a ng After loading images from DX VIEW into DX MAMMO the following Start Page appears There are several ways to display the images in DX MAMMO Use the Hanging Protocol Mode highly recommended or Use the Automatic Image Positioning icon in the toolbar or Use the Study List
13. right click CTRL right click Shift right click Those settings can easily be copied onto other workstations as they will be stored in the Mymenu ini file under DX MAMMO lt settings Choose whether to open the menu with a right click right click and SHIFT or right click and CNTRL Choose a tool from the right hand list and press the arrow button pointing left With the up and down arrows you can change the order of the information You can change your personal menu or work with a default menu ie Rteres ng ors oe ome e 1 w 19 9 7 INITTAL IMAGE ADJUSTMENTS This feature contains a Rule system to read hanging relevant information from different DICOM tags Up to 99 rules can be stored Those settings can easily be copied onto other workstations as they will be stored in the initial ini file under DX MAMMO settings For the correct use of Hanging Protocols it is necessary to have the following DICOM tags correctly filled SOP CLASS UID 0054 0220 View Code Sequence SOP CLASS UID 0020 0060 Laterality If that is not the case on your site you can map other tags to the needed tags using the initial image adjustment tool The corresponding mapping rule could read as follows Mapping of 0018 5101 View Position and 0020 0060 Laterality to 0054 0220 View Code Sequence Mapping of Series Description to 0054 0220 View Code Sequence Terres vant Maes oF A Murat Valle 57 Sy On NOT s
14. P for review or quality control control 2 x 5 MP for diagnostic use 2x 9 MP or 2 x 15 MP for diagnostic use SPECIFICATION MINIMUM RECOMMENDED Graphics Graphics card for control monitor resolution of 2 1280x1024 True Color mode 8 bit gray output any ATI graphics card Graphics card for diagnostic mammography displays resolution of 1536x2048 or more True Color mode 8 bit gray output any ATI graphics card with gt 1 GB RAM and gt 256 bit memory bandwidth e g DX GRAFIX PRO Optional third graphics card for control monitor resolution of gt 1280x1024 True Color mode 8 bit gray output any ATI graphics card Graphics card for control monitor resolution of gt 1280x1024 True Color mode 24 bit gray output any nVidia graphics card Graphics card for diagnostic mammography displays resolution of 1536x2048 or more True Color mode 24 bit 8 bit gray output any nVidia graphics card with gt 1 GB RAM and gt 256 bit memory bandwidth e g DX GRAFIX PRO Optional third graphics card for control monitor resolution of gt 1280x1024 True Color mode 24 bit gray output any nVidia graphics card Additional Hardware Logitech G600 mouse Programmable keypad to provide one click access to frequently used functions Gf needed Additional Software DX VIEW PRO 2 8 0 dl Note Loading of DICOM data from remote archives or from directories media Only studies and series already availab
15. USER MANUAL TABLE OF CONTENTS INTRON 3 2 SYSTEM REQUIREMENTS vvs 4 2 1 Minimum system requirements rrrnnnrnnnvrnnrrnnnrnnnernnernnnennnennnennnnennnennnennnnennnennnennnnennnennnennnnennnennnennnnennnenenesnnee 4 2 2 Recommended system requirements rrrnrnnnrrnnnrnnnrrnnernnnrnnnennnernnnennnennnennnnennnennnennnnennuennneennnennnennnennnennnenenesener 4 s INSTALLING THE SOFTWARE jr aeknenn 6 TENT a tiO iee E 6 SV ke FTN CIN ICA WIG EEE T 4 UNINSTALEING THE SOFTWARE wccsccacsevsdecveceecassseitveseacseceossenstacsacussoaveceisesuncicvousecetsseebensvansesvscadsccdeveveucasvout 9 TALINT ENAN E aineena E EN EEEE N EEE OEN 14 TEE EEE ESEE RE NT NN SN A E E 14 TILDA hr 15 ISOFTWARE NNN IN 16 9 1 DICOM tag information cccsecccesssccceseccccenecccesecccescceeenececasscceenecceeeeceseessceeensscseenesesensceseneccseeneseeees 16 Tele jekker 17 r HOLME EG ASTA EEE EEE EE EE EATE A AE TEA E 17 OA Preset unction SN Lendl EENE ENEA ETa 18 go My Toolbar eds deaeoker 19 9 6 My Menu setting rrrerrnnrrnnnrnnnrrnnrrnnernnnennnernnernnnennuennnennneennuennnennneennuennnennnennnnennnennnenennennuennnennnnennnennnenennennnennn 19 O 7 at EN WAS 8 KG ERE EE A AO O 20 TN 21 9 8 1 Create Hansine Porduaapasnsmesese eneeier 2l 9 8 2 Recommended hangingg rrrnnrrnnernnnrnnnrrnnernnnernnernnernnnennnnnnnennnnennnennnennnnennnennnevnnnennuennnennnnennnsnnnennnnennnenen 24 RE 0 ac le 00 2 EEE ERE EEE EEE 26 gg aC setto REE
16. ages It is possible to set different overlay settings for different modalities Simply define the modality from the drop down list at the top right corner of the window Define the corner of the image you want to work on Choose DICOM tag from the right hand list and press the arrow button pointing left With the up and down arrows you can change the order of the information The show scale button enables the Scale feature automatically see chapter 10 4 2 Display Note The orientation of the annotation position can be flipped for images of the right breast to avoid overlapping with breast tissue Please see chapter 9 9 3 for further information 9 3 SHORTCUT SETTING Key combination shortcuts give and easy access to specific post processing tools Up to 99 shortcuts can be configured and stored in DX MAMMO In Chapter 12 you will find an overview of some recommended shortcuts The settings will be stored in the Keyassign ini file under NDX MAMMO settings Once defined they can easily be copied onto other workstations sete eF 17 simply double click on a feature from the left hand list and press the key combination desired Planen het hey fo seng Comment Carnal Ifa tool has been defined before press release before changing the key combination For a better overview of key combinations and their corresponding shortcuts please refer to the keyboard map ro i Q MAMMO ja w T
17. box is unchecked all modalities are excepted for loading O Specify Manufacturers which have used magnification factor to calculate the image pixel spacing 35 10 USE OF SOFTWARE APPLICATION 10 1 LOADING IMAGES DX MAMMO is configured as the primary viewer Make sure that all images are stored locally in your imagebox Highlight one or several studies by checking the checkbox in the first column and click on the DX MAMMO viewer button D re mo Jos acam waan FP Ks br t r re Dare d barta Vuty e DX MAMMO is configured as the secondary viewer Make sure that all images are stored locally in your imagebox Right click onto a study in the study list and choose Open images in secondary viewer from the _ drop down list d gem J 0 meea cw Uet fue suns euan P mone Tema 7 Sure Pee esec _ ete eran tone GE 2 ad J l Fj moe meget a rza NOTE To change the primary and secondary viewer please refer chapter 3 3 for further details 10 1 1 ADDING IMAGES TO A CURRENT HANGING It is possible to add images of a more recent study to your current hanging by Choosing a study from the DX VIEW study browser without closing DX MAMMO beforehand and Loading this study 36 10 2 USING HANGING PROTOCOLS 4 different Hanging Protocol modes are available The following is a recommendation for their use Normal No Protocol will be applied e g for Spot ima
18. e all measurements and figures either in the selected or in all windows Note All measurements are valid for the projection plane only 48 7 Masking Masking Too Helo E Masttong from the lower sde Masking from the upper side A Oblique mating Band masking Rectangulat masking E Cacular masking Free mask ng i Rectangular Diocdke E Carcular blocker Pa Im lant blocker c000 Be Release masking s and blockerts x Selected windows A ud a X AN windows je Masking from the lower side after activating this feature and clicking once into the image a shutter will overlay the image from the lower border of the image up to the mouse click area move the masking by clicking into the masking into the black area cursor has changed into hand Masking form the upper side after activating this feature and clicking once into the image a shutter will overlay the image from the upper border of the image up to the mouse click area move the masking by clicking into the masking into the black area cursor has changed into hand OblDXue masking It is recommended to move the oblDXue shutters both parallel to the pectoral muscle and at an angle of 90 degrees to it move the masking by clicking into the masking into the black area cursor has changed into hand Band masking after drawing a square into the view shutters from the top and the bottom will appear They can be dragged up and down by using t
19. een te a rere tweed tay Senet te hpa re ent md gt ee 3 9 4 PRESET FUNCTION SETTING Here you can configure specific F Key features e g Window or Contrast Settings or command assignment of any command from the toolbar Window level individual Window Width Centre and Gamma Values can here be defined if value 0 has been set the values of the DICOM tag are used The Initial Button defines whether these settings shall be active straight from the beginning of reading or only after activating by the F key NEED T NEST PANNE TA eee ee es meme ee o t e b de ee G 00 l rere _ ires i ee ME I Seese ve D See ETTE eee 18 9 5 MY TOOLBAR SETTINGS The configurable toolbar gives an easy access to specific post processing tools Up to 99 entries including separation bars between buttons can be stored Those settings can easily be copied onto other workstations as they will be stored in the Mytoolbar ini file under NDX MAMMO settings Choose a tool from the right hand list and press the arrow button pointing left With the up and down arrows you can change the order of the information You can change your personal toolbar or work with a default toolbar 9 6 MY MENU SETTING The Menu on the right mouse click gives easy access to specific post processing tools Up to 99 entries can be stored in 3 different menu lists
20. es Draw breast face lines marks the skin line of the breast for better visibility An offset processing of outside breast region s the detected breast domain will be offset and processed outside 29 9 9 5 READING CONDITION 2 Cay WOT diegtay iw On shes ng iQ MAMMO EE ENE One Touch initialization will perform the following adjustments Automatic vertical positioning adjustment of up and down position corresponding to the contra lateral side Automatic breast region detection detects the skin line of the selected image or of all images and blackens everything around the breast Recognizing the skin line is necessary for the automatic vertical positioning as the nipple will be used as a marker Automatic margin cut cut of unfilled space and filling of white spaces with black This will be helpful for digitized images as they often have under exposed areas on the image Adjustment of gamma value the calculated gamma value from the histogram is used to adjust contra lateral images It is also possible to carry out automatic density adjustment of all contra lateral images In an automatic positioning image arrangement process Apply it in all windows Max 8 maximum of eight images contained in the loaded studies will be loaded into the viewer The images not shown in the current tiling can be displayed by using the arrow lt buttons Unless the checkbox is marked a maximum number
21. et gt vedr 714 TOT COA og toten 7m J TOTOO 9 tOrOVGTON 32 Draw Mode gradation defines the different resolution options available in each tile of the viewer and the primary initial mode To increase the resolution of the monitors by 3 when using the ISD Technology Independent Sub pixel Driving by the manufacturers Totoku or Sony simply Check whether the ISD modes are activated bottom two options and Check whether ISD is enabled in all fields of the viewer Simply click on the little field in the bottom right corner of every tile till it shows ISD NOTE When using Sony Monitors a specific library is required IMAGE Information Systems will supply this DLL with the delivery of the monitors 9 10 4 ADDITIONAL HANGING PROTOCOL SETTINGS i Parag or Qt 4 _ Cornffguewter Writ Omarg UTE OO ae ort y Otters ares ssiri am ske Bore ert bag aar pap Pp a Margery potoa w Aert Gal sko Wee Polsky o Pogo aerate of ar gee wet ao Vg GO al ma ice MO a Davi Oah Fy Taai Dapit Poet Coke 1 8 rv a Ongi 1 1 2 f E r i F 4 s Celgret ted une re gt gt are sd ket am gre m s e ea we Chee Compare Reading replaces the past image with the current one Hanging Protocol o Automatically skip a step including no images a HP step will be skipped if there are no images corresponding to it in the
22. ete T o Lant 2 Serer 18 epee Other possible rule based changes are Adjusting window level width center and gamma e g o Equilibration of image perception of any vendor to the current one e g smoothen Hologic images or harden of FUJI images Apply image rotating or mirroring Reverse Left or Right image rotate or flip image right left up down or 180 degree Change the location of the hanging relevant mammogram information Apply Sigmoid curve or image inversion sometimes needed when hanging Hologic images 20 9 8 HANGING PROTOCOLS 9 8 1 CREATE HANGING PROTOCOLS This Hanging Protocol Manager controls the automatic hanging tiling sorting and preset viewing of pre defined image sequences Up to 30 views can be stored in 3 different protocols Those settings can easily be copied onto other workstations as they will be stored in the Hangingprotocol ini file under DX MAMMO settings The recommended use of those 8 protocols is as follows o Single Mammo Hanging o Dual Mammo Hanging o Large Breast Hanging The following workflow describes the different steps necessary for creating your personalized hanging protocols 1 Choose one of the three protocols at the top of the window s gt G Ova p E Note It is recommended to have the most commonly used set of hanging steps in protocol 1 and the least commonly used set in protocol 3 2 Choose a Hanging Prot
23. fter drawing a line a new window opens showing the histogram across that region 47 ROI selected region after drawing a circle circle can be auto completed using a straight line from the end point to the beginning point of the circle a new window opens showing the histogram of this region ROI breast region after selecting a view a histogram will be created including the whole breast region ROI and circle annotation after drawing a ROI Standard option or one click into the area of interest creates a circle Simple option a histogram of this area will be shown in a new window Arrow creates an arrow after drawing a line toward the area of interest Standard option or simply clicking on the area of interest Simple option Annotation after activating simply click into the area where you would like to have the Annotation an additional window opens allowing you to write your Annotation and define the Font Size Circle creates a circle after drawing a line through the area of interest Standard option or simply clicking on the area of interest Simple option the predefined circle size can be changed by drawing an appropriate circle with the Standard option right click into the circle and setting the current value as default Clear to erase a measurement or annotation simply activate this feature and click on the measurement you want to delete Delet
24. ges Protocol model Protocol 1 will be applied e g for reading single studies no Hanging step bar will be shown at the left bottom corner of the screen Protocol mode2 Protocol 2 will be applied e g for reading two studies Protocol mode3 Protocol 3 will be applied e g for reading large breast studies containing multiple CC or MLO views for one or both breasts After restarting the program DX MAMMO will switch to the last used Hanging Protocol mode 5 Q MAMMO PE rm sr avigato ET NE Mel Image pocs gt gt O y o F i Al Normal id gt Next reading step Protocol modei rm gt Previous reading step Protocol mode SOE Traas l I Protocol mode3 zad I Protocol switch To move between the different hanging steps simply use the forward and back buttons in the lower left corner of the DX MAMMO application To select a specific hanging protocol step use the drop down box Once the last Hanging step is reached it will automatically step to the first step went clicking the forward button only if Loop feature is activated EL a CR A ES 7 rte mh lew kai Es roe Pl l eweguteree FT One oF Upare Fi Uewegeteret fo Livegelered PO Gre pen si FT eve NOTE A hanging protocol step containing no images e g left CC compared with left MLO after breast ablation left will be ignored using the forward back buttons 37 10 3 MOST COMMONLY USED FEATURES 1 Mouse keys
25. he handle after clicking into the dark masked area move the masking by clicking into the masking into the black area cursor has changed into hand 49 Rectangular circular free masking different tools to define the shape of the masking tool outside masking move the masking by clicking into the masking into the black area cursor has changed into hand Rectangular circular free blocker different tools to define the shape of the blocking tool inside blocking Implant blocker it is possible to mask all breast tissue with a similar density e g an implant showing high density tissue only Release masking s and blocker s in either the selected or all windows 8 Tool This menu is described in Chapter 9 DX MAMMO 1 2 0 User Manual CON INT EN 002TR 50 9 Help Log This feature is described in Chapter 7 User Manual opens the current User manual as PDF About additional information about the product version and the distributor is provided ol 10 5 3 VIEWER The Viewer is the main work area in which the loaded images are displayed and processed Changes e g windowing zooming panning flipping rotating etc and additions e g measurements and annotations to images are made in the image processing area M Patient data Laterality and view position Siem Image data dell 1909h Svmmetn Symmetry Monitor Page number Symmetry ON OFF config and switch Patient and image data
26. hem to supportQimage systems biz 14 8 FOLDERS This chapter contains a basic structure of the installation folder It should look like the following DX MAMM Oxsettings Customer initial images adjustment mymenu mytoolbar and shortcuts settings folder DX MAMMO settings default Default initial images adjustment mymenu mytoolbar and F key settings folder DX MAMMO settings presets Custom F key settings folder NDX MAMMONmodules Different monitor and IDS drivers folder 15 9 SOFTWARE ADMINISTRATION Most configurations can be done using the Tool menu in the top menu bar Other settings e g the Monitor size settings can be made using the service setting program please refer to chapter 9 10 for further information The following chapters describe the different menus found in the Tool menu entgrveteqn Vetter Creer Mr y hoti Vaa sv fey tert at Ub wtes t s DICOM tag information Text overlay setting Shortcut setting e EKSA ee er rutere teen Model te Urter T sen fe Preset function setting My toolbar setting r yV menu setting wees Dente v Cat eee bee me Initial image adjustments setting ranging protocol setting fl General setting 9 1 DICOM TAG INFORMATION Using this feature it is possible to view the DICOM tag information of the active image 16 9 2 TEXT OVERLAY SETTING Using that simple tool you can define the information shown on the im
27. is bar is not visible It enables you to go forward or backward steps in your Tomosynthesis sequence or to choose a speed and run automatically through the stack of images It also shows you the current step in the middle of the bar ed O os 230000 a ME 10 5 6 IMAGE PREVIEW BAR The preview bar can be used to get an overview of the images loaded into the viewer The thumbnails in the preview bar can be used to manually populate the views in the image viewing area by Dragging an image thumbnail from the preview bar to a tile of your choice Double clicking an image thumbnail to load it into the currently active tile blue frame It is possible to configure the information displayed in the Image Preview bar see chapter 9 9 2 10 5 7 STUDY LIST The preview bar can be used to get an overview of the studies loaded into the viewer The studies in the study list can be used to manually populate the views in the image viewing area by Right click into the study and confirming Automatic image positioning The study will be loaded into the current tile layout It is possible to configure the information displayed in the Study List see chapter 9 9 2 or to change the order of the columns shown by dragging and dropping the column headers 53 Patient name Patient ID Se Study date Study description Demo4 10 5 8 VIEW POSITION MATRIX This Matrix shows the c
28. le in the local DX VIEW imagebox can directly be opened in DX MAMMO Studies stored on remote DICOM archives on media or in directories have to be imported into the local imagebox before they can be transferred to the mammography viewer Therefore the DX MAMMO button and menu entry will only show on the Database tab They will be disabled when switching to the Network or Filesystem tab In case DX MAMMO is generally set as primary viewer the option Just retrieve images dont show might be activated in the Local settings see the DX VIEW 2 8 0 Administration Guide This will retrieve studies from remote archives Network and Filesystem without loading them into the DX VIEW viewer Afterwards you can switch back to the Database tab and open the study with the mammography viewer Note It is recommended to run the application with administrator rights Please do the following 1 Right mouse click on the desktop shortcut or the mgview exe 2 Click on Properties 3 Click on Compatibility 4 Check Run this program as an administrator 7 MAINTENANCE The software itself needs no maintenance However it might be helpful to the Administrator to check the log file regularly for irregular performances 7 1 LOG FILES The log files can be fi otind v The DX Mammo log file can be stored at a location of your choice They are needed in case of support requests Please send a copy of t
29. lected or all windows Automatic gamma adjustment The gamma value from the histogram of the image is calculated and automatically adjusted in the selected or in all windows Automatic margin cut cuts the margin automatically in the selected or in all windows and colours the background in black Automatic breast region detection this feature detects the skin line of the breast This 1s necessary for inverting only the breast tissue and for the automatic breast alignment 5 Image Processing Window level adjustment for all windows copies the current window settings from the active window to all other loaded images Zoom all windows or selected window mouse point zoom when clicking in the image mouse pointer has changed Magnifier activates a magnifier lens overlay in the active window during left mouse click an additional right mouse click on the active lens opens the Magnifier settings dialog _ Shape 3 shape options square circle rectangle 44 Scale 11 scaling options Magnification fro m x1 to x10 or Pixel by Pixel 100 Scaling Brighlight oS Magnifier re Inverse ON OFF switches the Inversion of the Magnifier overlay ON OFF Symmetry ON OFF switches the Magnifier overlay on the opposing image ON OFF Magnifier remain ON OFF switches Magnifier remain option ON OFF Magnifier overlay remains active after releasing the left mouse button and will be deac
30. ocol Step Title and a tiling type 21 3 Click onto a tile and choose set the attributes oo i i i Riis amp i er owe 4 Select out of the given settings Past study th previous It starts from a selected _ Oldest study _ Tomosynthesis image Y Image type Lateralty View code View modifier code Y Scale Original 14 Fit rm lt Position of Magnification Upper Central Condition Condition ee 0 LI in this tile e g o Show selected study O O o Show Tomosynthesis image Y Window level 9 Not apply any parameters _ Apply function preset parameters Set parameters Window 0 Gamma O V Others Apply mirror Symmetry _ Inverse Target study Use these checkboxes to define which studies of the chosen patient you want to view Show most recent or any other previous 15 or 2 or xxx previous study Comparisons with the oldest study is possible as well choose oldest study 22 Image type with these drop down boxes you can define the view position used in the Field Code Sequence 0054 0220 and Code Value 0008 0100 to be used in your hanging Choose one of the following options o Laterality R or L o View Code MLO ML CC FB LMO LM SIO XCC XCCL or XCCM o View modifier code CV AT RL RM ID M S or TAN Scale If you wish to just highlight a specific Sec
31. of loaded images are 4 Apply it to the last image existing the same image s in case two or more images of the same view position and laterality exist in the loaded study only the newest image will be displayed Do NOT apply in the process data image the image transmitted from the modality before image processing will not be displayed 30 9 10 ADDITIONAL SERVICE SETTINGS With the Service Setting tool more configurations can be made Simply open the SeriveSet exe and log in The default Administrator Name is lis and the default password is climb User Loge tor Server Setting gt n Posse cich Login after entering your narre and password er ie f P 9 10 1 CONFIGURATION SETTINGS Se ng for MAN Cort gater Mente Omeng Pegg oooi Minar bek bey Otters foret etre T as oe TSG Se bg Gre el Kam Hua tothe oat hate AN Te PE seter F the foe meted of ferent corer Oe mere ee tence ie of tee rere 1 Geam Pee merne W irao resing O Amh a Ar Jo a tewi 7 rth LE a Tes em sd pr One Personal Settings different configuration settings can be stored depending on the windows User o Save user settings by using personal folder configuration settings of the installation folder will be ignored o Personal Folder Path following settings will be stored under this path F key and keyboard shortcuts Hanging protocols initial image adjustments mymenu and m
32. snennenennssnnnee 39 VITEN 40 LET AS Na REE EEE EE PEN RENEE RE NER 40 VM 41 DD NN 52 10 5 4 Hanging Steps bar for MG images errrvrrvnnrrnnnrrnnnnrnnnnrrnnnnenennrnnnnennnnvnnnnnennnnennnnnnnnsnnnnnennnnennnnsnnnnnenenee 52 10 5 5 Hanging Steps bar for Tomosynthesis Images rrrrrrrrrrrrnrnrrnrnrrnnnnrrnrnernrnerernnennnnerernernrnsennnnernnnerernssennee 53 VNR 53 TANN 53 TVEN 54 ILABBREVIATIONSAND ACRONYMS vvs 55 PIET TR NTT 56 1 INTRODUCTION DX MAMMO is a software application for viewing processing and reading computed radiography mammographic images direct flat panel images ultrasound images and Tomography data DX MAMMO can be used for both screening and curative reading DX MAMMO is an optional module for the DX VIEW and DX VIEW PRO viewing software and shall therefore only be used in conjunction with an DX VIEW PRO license 2 SYSTEM REQUIREMENTS 2 1 MINIMUM SYSTEM REQUIREMENTS SPECIFICATION MINIMUM RECOMMENDED men f Operating System Windows XP Professional 32 bit Windows 7 Professional 32 or 64 bit re es Graphics Graphics card resolution of gt True Color mode 24 bit nVidia 1536x2048 True Color 8 bit gray graphics card output any ATI graphics card Additional Software DX VIEW PRO 2 8 0 2 2 RECOMMENDED SYSTEM REQUIREMENTS a C ES Hard Disk gt 500 GB S ATA II hard disk drive solid state drive SSD HDD Monitor 2 x 3 MP for review or quality 2 x 9 M
33. tivated with another left mouse click Magnifier Window selected from the toolbar opens an additional window zoom up to 600 and or inversion possible a Histogram will instantly be updated 45 Pan use the Pan button to activate this feature or use the pressed mouse wheel to activate it Symmetry switches the symmetry feature in the selected or all windows on off Initial Scale switches to the initially defined scaling size in the selected or all windows on off the symmetry feature can be additionally applied by means of the toolbar buttons Original 1 1 switches the 1 1 life size zoom in the selected or all windows on off Zooming scale Gives you three zoom options to be applied to the selected or all windows on off the symmetry feature can be applied additionally using the toolbar pace trast emprovernernt frit Unsharp Mask Image processing of an unsharp mask is carried out in the selected image Other high performance filter 000 Inside diameter EN men 000 EK Canai 4 Display processing resuk with another window 46 Subtraction Overlays one image with the other side to see deformities on one side easier move one image using the cursor keys up down and right left NOTE This feature does not support color or 8bit images 6 Measurement Distance enables distance measurements Histogram a
34. tor Sector View of the breast within the Hanging Protocols please use the Scaling Option and the Position of the Magnification e g o Use Position Upper and Fit to 200 to view the upper Sector on the MLO view or the outer Sector on the CC view o Use Position Lower and Fit to 200 to view the lower Sector on the MLO view or the inner Sector on the CC view Window level Here you can either specify a specific window and center value or apply a specific F key function please refer to chapter 9 4 Other o Apply mirror This feature mirrors the image before viewing o Symmetry It is recommended to use the Symmetry option in this field as this enables a faster comparison when symmetrically masking or changing the opposing images o Inverse This feature inverses the image contrast before viewing It is further possible to apply specific conditions to the selected view e g only load the image in this window if the tag Manufacturer and Institution name are as described After finishing close the window with OK 5 Define all other tiles as well and add another Hanging Protocol Step s r i i i a i i EREBEB 6 After finishing close the window with OK 23 9 8 2 RECOMMENDED HANGINGS 1 Single study Please adapt and change those protocols according to your needs Comparison of all images Comparison of the MLO images Comparison of the CC images Comparison of the left side images
35. urrently loaded view positions and their orientation on the patient 54 11 ABBREVIATIONS AND ACRONYMS ABBREVIATION M1 w fome OOOO SS Dr Digs Raairapty ID Implant Displaced Left side Latero medial Latero medial oblDXue Magnification z Medio lateral L Medio lateral oblDXue Q Mammography 5 Magnetic Resonance Other Picture Archiving and Communication System Right side Rolled Lateral Rolled Medial Spot Compression PACS J og V Q Secondary Capture Yn O A Superolateral to inferomedial oblDXue Z Tangential Ultrasound N XCC Exaggerated cranio caudal XCCL XCCM Cranio caudal exaggerated laterally Q Cranio caudal exaggerated medially 55 12 LIST OF SHORTCUTS This chapter recommends a list of keyboard and mouse shortcuts that can be used in DX MAMMO SHORTCUT SCOPE Shift D One HP step forward Shift C One HP step back Shift B Switch to next HP mode 1 numpad Switch to HP mode 1 2 numpad Switch to HP mode 2 3 numpad Switch to HP mode 3 0 numpad Switch HP OFF Shift K Switch Magnifier ON Shift M Reset zoom to initial scale Manual Vertical Pos Activate manual vertical positioning and OFF
36. y toolbar settings annotation and general configuration settings Description the number of patient names to be displayed can be set here Performance to increase performance it I recommended to enable threading and to accelerate the image interpolation as it is set by default l 9 10 2 MONITOR SETTINGS Ceefgeeten Vater Hr g Pamm Meee s fey Cotes ee Ma ek 3 that ote TT f t v nh 048 Pwel i ruget 4 mr fs 6 ver reg lar eee Peete T Gel Vewer ete meg t ft Tap 4 lam ore ise Number of Monitors influences the viewer width in an automatic viewer position setting Manufacturer influences the ISD options in the tab Drawing o If this setup differs from the monitor more then 10 bit gradation is not carried out Orientation of the Monitors Monitor Size o Windows Division Mode e g enter 21 when 2x1 defines how many tiles are displayed in the Normal setting no Hanging Protocol active 1x1 gt 11 2x1 gt 21 4x1 gt 41 o Length and Width of the viewer window in mm and Pixel refers Viewer Position adapt the window size automatically or manually o If automatic setting is chosen Viewer Position and Number of Monitors become inactive o Ifyou choose to size manually take into account the number of monitors you choose 9 10 8 DRAWING SETTINGS CONFIGURING THE ISD MODE Corfgewten Vera Orr Hegg una Mae ore Fey Omer Cree de getter velt k
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