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1. 219 Chapter 19 The IDEXX EquiView Digital Imaging System 7 Dangerous voltage Alternating current 19 10 4 FCC Class A Verification Information to the user This equipment has been tested and found to comply with the limits for a Class A Digital Device pursuant to part 15 of the FCC Rules These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with this Operator s Guide may cause harmful interference to radio communications Operation of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense 19 10 5 General Safety Information WARHIHG WARHIHG A WARHIHG A CAUTION The EquiView system and associated cables must not be operated in the presence of moisture To avoid excessive electrical dangers proper grounding of the product is required The Control Box s power cord shall be connected directly to a hardwired AC Mains receptacle If an extension device is needed it must be pre approved by IDEXX The use of any other electrically powered device with the Control Box must be pre approved by IDEXX The EquiView system is not suitable for operation in the presence of a flammable anesthetic mixture with
2. 2 To add a log entry manually click Add Entry and enter information in the row that is added to the table 3 Use the buttons on the right to print email or export the log to a PDF file Click Close to close the radiology log 7 5 3 Viewing Printing Emailing and Exporting the Radiology Log To view print email and export the radiology log 1 Do one of the following e If you want to view the log for multiple patients acne Patient EE a From the menu bar at the top of the Imaging PEE Dashboard or Image Explorer window select Chant Pater Wet Dabe Ind jate Activities gt Imaging gt Radiology Log baat jaraarer b To select log entries to display fill in the x appropriate search text boxes and click ee Pami name tier BA Search For example you might want to siy use the Start Date and End Date text boxes to select all the log entries during a certain period of time T ai Ta ee a iF uu a a Note If you are on the Image Explorer window and have a patient selected the radiology log opens with information for that patient displayed To search for different information click Clear and use the search fields e f you want to view the radiology log for a specific patient open the patient s record on the Patient Clipboard and then in the Patient History area Figure 7 3 The Radiology Log f right click and select Radiology Log igure 7 3 The Radiology Log for a patient Chapter 7 Othe
3. To capture images with newer IDEXX I Vision CR scanner software Chapter 10 Capturing Images e Click the Presets tool and select Original As initially displayed to restore the window and level to the way they were when the image was captured Another cassette can be scanned when both lights are green and steady If you want to capture an image for a different exam type next click that exam type to highlight it Repeat these steps until you have taken all the images for this patient All captured images are saved to the database when you click Done Capture to complete the capture process TIP The shot tree menu contains other features that allow you to customize A newer version of the scanner software for the IDEXX I Vision CR system is available if you are your image capture session See using the Windows 7 operating system With this upgrade you no longer need to reselect the 11 3 Dynamic Shot Tree Features for view on the blue scanner interface window Contact IDEXX Digital Imaging Support at 1 877 433 Capture for more information on 9948 for more information or to upgrade 1 e Adding an exam type In the shot tree area on the right of the Image Capture window the first exam type in the list is automatically highlighted e Looking at the images you have taken e To take this image continue with step 2 e To take a different image click the exam type for that image to highlight it IMPORTANT For best
4. 1 Be sure that the scanner is turned on and that the scanner status indicator is steady green Chapter 18 The IDEXX I Vision CR Digital Imaging System 2 Oneither the Imaging Dashboard window or the Image Explorer window click Capture Images as if you were beginning the image capture process The Select Client and Patient dialog box appears 3 Type the name or ID of any client or patient in the Search box and click Search Next Capture THX VD The Capture Setup window appears No images will be captured for this patient 4 Select any exam type in the Choose Exam Type area and click Next The Image Capture window appears 8 3 5 Insert the cassette into the scanner See 18 3 1 Loading a Cassette for more hl information Thickness 6 Click Erase When the erasure process is finished the scanner ejects the cassette orm 24 48 EEEE 7 Click Done Capture to close the Image Capture window No Wage k saved Figure 18 6 The Cassette Tools and Erase buttons on the Image Capture window 18 3 4 Cleaning an Imaging Screen If you begin to see artifacts such as white specks on images the screen may need cleaning The screen may also need to be removed from the cassette to remove hair fibers or dirt Follow these guidelines e Never touch the top surface of the screen with your bare hand Always wear gloves when removing and cleaning the imaging screen Clean dry soft powder free latex or nitrile gloves may be
5. 19 3 2 Disinfecting The EquiView system must not be subject to a bath disinfection sterilized in an AN autoclave or put into another device for sterilization The EquiView system can be CAUTION wiped with a disinfectant The method of disinfection applied must correspond to the applicable legal regulations and guidelines on disinfecting and explosion protection Do not use corrosive solvent or gaseous disinfectants If you use disinfectants that form an explosive gas mixture they must evaporate first before you turn on the device To disinfect e Turn off the power before disinfecting the device e All parts of the device including accessories and connecting cables must be given only a wiping disinfection e Do not use a spray disinfectant because It can enter the device If you use a room disinfectant atomizer turn off the EquiView system and remove it from the area before using the spray disinfectant Wipe the EquiView system with disinfectant 204 Chapter 19 The IDEXX EquiView Digital Imaging System 19 3 3 Maintenance Maintenance consists of checks that the operator can perform and service performed by IDEXX within the scope of service contracts by service order or by persons expressly authorized by IDEXX to perform such tasks Like all technical devices the EquiView system requires e Correct operation e Regular inspection by the operator e Regular maintenance and servicing These measures help you mai
6. 209 Chapter 23 Using the IDEXX Vision Mobile Application Tap El in the upper right The Add bookmark window opens In the Add to text box select Home screen then tap OK 7 Goto the Android Market and download the Dolphin Browser application Dolphin for Pad version 8 Accept default settings in Dolphin setup wizard except on the User Agent screen select iPad 9 Tap A tap Dolphin Settings on the left and select the Full screen mode check box 10 Close browser 11 Tap the IDEXX I Vision Mobile Application icon on desktop to start application From now on always use the icon 23 4 The Screens in Depth The following sections explain how to interact with the screens of the application 23 4 1 Patient List The mobile application opens on the Patient List screen You can have this screen display Patients currently checked in to the census list Patients who have recently had imaging activity Results of a patient search Py vmobile ii E wor When Patient List opens or you tap _ the list shows Augustina eed it G F kik i Aen tar 7 Sete 22 n anil e if I displayed checked in patients Census List M Fluffy owe heus o z l i eel Pa Cri g I rera l ee d Fa e if 4d displayed patients with recent imaging activity Imaging Dashboard pf Rocky fe Dated hi Requests you create on a tablet will be visible in the same places as other SmartLink Digital Imaging requests you create For more informa
7. Click the Specialist Interpretation text box and press CTRL V The specialist s comments are pasted into the patient s record 7 Click Save and Exit To remove images from a case 1 On the Case Detail window if the Thumbnails pane is not open click Expand gt gt 2 select the thumbnail for the image that you want to remove If you want to delete more than one hold down the CTRL key and click additional thumbnails Click Remove The images you selected are removed from the case If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter 4 5 Case sending Actions Cornerstone allows you to send cases several ways such as saving cases to a CD emailing cases or sending cases by DICOM You can also send cases to telemedicine providers using the IDEXX integration technology for telemedicine as described in section 4 7 Sending a Case toa Telemedicine Provider with IDEXX Integration Technology The patient CD viewing software requires Java version 1 5 which is included on the CD To email cases you must have an email system configured on your computer To send cases via DICOM you must have the proper DICOM settings configured on your system In either case you must also have high speed Internet access because you will be transmitting large amounts of data To create a patient CD you must be using a computer that can burn C
8. You may want to add additional items to this group such as Radiograph consulting fee or Radiographs on CD 22 3 3 Additional Invoice Item Possibilities Create service type invoice items for emergency radiographs without identifying shots on the special action This lets you pick your shots at the time that you request the radiograph or the time that you capture it Create an invoice item called Radiographs without defining shots in the special action When you use the item do not select shots In this scenario the veterinarian communicates outside of Cornerstone to tell the technician which shots are needed The technician selects the shots at the beginning of the capture process The request is complete when the technician finishes the capture session study 244 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration Create an Extra radiograph invoice item for a lower price Such as 35 Use this item to reconcile extra shots taken outside a request These shots are called Not Requested shots and are shown on the Image Requests and Results window Create an invoice item that allows for picking shots on the fly by setting it up with a price of 0 and the Allow change option for pricing set to Require change If your practice has a standard per shot charge you can then wait to update the billing amount based on the number of shots selected for a particular request 22
9. 20 8 Environmental Conditions The detector panel and black box control box are designed to operate properly in normal living environments The requirements related to the operation storage and transit of these components are shown in the rest of this section Note Leaving the equipment in a car for long periods may expose the equipment to temperatures outside the ranges listed below and on the following page Note For better quality images do not place anything on top of the detector plate Operating Environment Ambient temperature 50 F to 95 F 10 C to 35 C Humidity 20 to 75 RH noncondensing Max rate of change lt 18 F 10 C per hour Pressure range 500 to 1060 hPa Note The IDEXX I Vision DR System must not be operated in conditions where condensation can form in the device Operate the device only under the operating environment conditions described above 221 Chapter 20 The IDEXX I Vision DR System Storage Environment Temperature 32 F to 104 F 0 C to 40 C Humidity 5 to 95 RH noncondensing Max rate of change lt 27 F 15 C per hour Pressure range 500 to 1060 hPa Transit Environment Temperature detector plate 50 F to 95 F 5 C to 40 C Temperature black box 40 F to 113 F 40 C to 45 C Humidity 5 to 95 RH noncondensing Max rate of change lt 27 F 15 C per hour 20 9 Safety Information 20 9 1 Safety Statement The operator s guide and this supp
10. 50 60 Hz Reader and plate operating temperature 64 F 86 F 18 C 30 C Relative humidity 80 max noncondensing 166 Chapter 16 The IDEXX CR 1417 Digital Imaging System Connection to PC USB device Imaging plate sizes 8 x 10 20 cm x 25 cm 10 x 12 25 cm x 30 cm and 14 x 17 85 cm x 42 5 cm Note The software that runs the IDEXX CR 1417 system scanning process does not support the Microsoft Windows Vista or Windows 7 operating systems 16 6 Safety Information For your protection and for the protection of the equipment use the IDEXX CR 1417 system only in the manner outlined in this user s guide The Certification and Identification Label is permanently affixed to the rear panel of the IDEXX CR 1417 system scanner WARNING LASER HAZARD The IDEXX CR 1417 system scanner is a Class laser product with a Class IIIB laser The laser has a visible light output of up to 650 nm and output power of up to 30 mW Never attempt to operate the reader while the cover is removed as laser light can cause serious injury to eyes and skin During normal operation the cover should not be removed Removing the cover should be done only for service purposes by a qualified technician Seek medical treatment immediately if exposed to the laser light WARNING INJURY DAMAGE To reduce the risk of serious personal injury or equipment damage never remove the cover of the IDEXX CR 1417 system scanner There are no user servi
11. Chapter 19 The IDEXX EquiView Digital Imaging System e IDEXX is responsible for the safety features of its products only if servicing maintenance and modifications have been carried out by IDEXX or by a person expressly authorized for this purpose by IDEXX e Like all technical devices the EquiView system needs proper operation regular maintenance and care as described in this chapter of the Cornerstone Digital Imaging Users Guide e f you use the system incorrectly or if you neglect to carry out proper maintenance IDEXX cannot be held responsible for resulting errors damage or injuries e Safety circuits may neither be removed nor modified e Safety cannot be ensured if users open the casing of any hardware component of the EquiView system or remove parts from any component 19 10 2 Applicable Standard This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions may cause harmful interference to other devices in the vicinity However there is no guarantee that interference will not occur in a particular installation If this equipment does cause harmful interference to other devices which can be determined by turning the equipment off and on the user is encouraged to try to correct the interference by one or more of the following measures e Reorient or relocate the receiving device e Increase the separation between the equipment e Connect the
12. In the Print Image Information drop down list select where you want the image text to appear e g along the bottom of the image in the bottom left corner etc Then select a color for the image information text black or white and specify the font size If you defined configuration elements for the DICOM printer select the element you want to use from the specific element s drop down list For more information see 8 12 Setting Up a DICOM Printer Note If only one value is defined for an element you cannot change that element s value If multiple values are defined for an element the default value is displayed you can change this value by selecting a new value from Figure 6 2 The DICOM Print dialog box for setting print order the drop down list Click Print The image is sent to the printer If you chose to print to batch the image is sent to the print batch queue To print images from the batch print queue 1 Choose Activities gt Imaging gt DICOM Printer gt Batch Print from the menu bar to display the Batch Print dialog box If you want to remove a print job from the queue and not print it select that row in the table and click Delete Click Print to print the jobs listed in the table Click Close 73 Chapter 6 Distributing Images and Using DICOM To edit batch print queue 1 Choose Activities gt Imaging gt DICOM Printer gt Batch Print from the menu bar to display the Batch Print dialog bo
13. You can edit all of these text boxes e Source and Modality These text boxes refer to the kind of equipment that was used to capture the image You can search for information in this text box on the Advanced Search tab of the Image Explorer e Keywords select keywords for the images in this series You can search for images with specific keywords on the Advanced Search tab of the Image Explorer window In the Series Comments area tyoe comments about the image series to which this image belongs These comments are attached to all of the images in this series Click the Technique Details tab Most of the text boxes on this tab are related to the radiology log For more information see 7 5 Using the Radiology Log Fill in any of the following text boxes for which you want to record information e Distance lype the distance from the x ray source to the detector or screen in the text box and select the unit of measure in the drop down list e Thickness cm Type the thickness of the body part being imaged in centimeters e Exposure mAs Type the amount of x ray exposure in milliampere seconds mAs This is calculated automatically if you enter values in the Exposure mA and Exposure time sec text boxes e Exposure mA lype the amount of current in milliamperes mA 66 Chapter 5 Reviewing Images e Exposure time sec lype the duration of the exposure in seconds as a decimal value or use the drop down menu to s
14. e Do not use a spray disinfectant sprays can enter the device e If you use a room disinfectant atomizer turn off the IDEXX I Vision DR System and remove it from the area before using the spray disinfectant 20 2 3 Maintenance Maintenance consists of checks that the operator can perform as well as service performed by IDEXX within the scope of service contracts by service order or by persons expressly authorized by IDEXX to perform such tasks Like all technical devices the IDEXX I Vision DR System requires e Correct operation e Regular inspection by the operator e Regular maintenance and servicing X ray a Sot ee Footswitch DR Relay Box ator These measures help you maintain the working order and the operational reliability Jeter of your device As the operator of the device you must abide by the regulations for prevention of accidents and the local medical product law as well as other regulations i 20 3 Equipment Connections l l _ Xray detector Figure 20 1 shows how the various pieces of the IDEXX l Vision DR System are Computer DR controller box i panel connected Note Image artifacts may occur if cables are damaged Be careful to keep cables out of walkways to reduce the risk of damage J Figure 20 1 IDEXX l Vision DR System connection diagram with the IDEXX DR relay box 218 Chapter 20 The IDEXX I Vision DR System Do not connect cable to the detector panel wh
15. 19 1 Background The IDEXX EquiView Digital Imaging System uses a direct energy conversion process with a selenium detector plate X rays are directly converted into an electrical signal without a light conversion layer By effectively eliminating the light diffusion present in indirect technology the EquiView system offers a sharper more detailed image The EquiView system provides a digital image capture capability for conventional radiographic examinations The system may be used wherever traditional x ray screen film cassettes are used Follow all safety labels on the equipment 19 2 Equipment Diagram Figures 19 1 and 19 2 show how the various pieces of the EquiView system are connected Note Image artifacts may occur if cables are damaged Be careful to keep cables out of walkways to reduce the risk of damage Do not connect cable to the detector panel while power is on or power is flowing CAUTION The detector panel needs to warm up for 30 minutes prior to use CAUTION Prep and Exposure Sequence To confirm correct setup check that the LEDs on the wired trigger box light up in this sequence 1 When the system is prepped and ready for exposure the LED on the wired trigger box turns from green to red 2 After you press the handswitch the system synchronizes with the X ray generator and the LED on the wired trigger box turns blue momentarily The system triggers the X ray generator to make an exposure The generato
16. Examples might include a PACS system or an external hard drive About your copy of Cornerstone L L L Do you currently have DICOM Imaging IDEXX PACS software or the Diagnostic Imaging module If you have an IDEXX Digital Imaging system do you currently have SmartLink Digital Imaging Do you currently store images from this device in Cornerstone 238 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration Work flow questions L Have you reviewed the work flow you will experience with this device and found it acceptable for the way your practice works For basic or partial integration Is the work flow of manually marking requests as completed acceptable for your practice 22 2 Setup and Work Flow Enhancements A flexible image request work flow is available for both IDEXX SmartLink Digital Imaging and Modality Worklist Integration The Image Request special action feature makes it easier to set up and maintain digital imaging invoice items Section 22 3 Imaging Integration Setup Examples describes a few of the most common ways that practices might choose to set up imaging integration in Cornerstone 8 2 and higher gt If you re new to SmartLink Digital Imaging or Modality Worklist Integration see section 22 4 setting Up Imaging Integration for instructions on how to get started 22 2 1 Transitioning from Earlier Versions of IDEXX SmartLink Digital Imaging If you had set u
17. IDEXX cannot guarantee the safety or proper functioning of this system if parts or accessories are used that are not supplied by IDEXX 196 Chapter 15 The IDEXX DR 1417 Digital Imaging System The safety features of the IDEXX DR 1417 system are only ensured if the following points are adhered to You should not use the system if it has any electrical or mechanical defects This applies in particular to display warning and alarm equipment If you want to connect the device to other devices components or assemblies other than those described in this chapter of the IDEXX Cornerstone Diagnostic Imaging User s Guide and if a hazard free combination with these devices components or assemblies cannot be deduced from the technical data you must consult the respective manufacturer to ensure that the safety of the patient the operating personnel and the environment are not affected by this intended combination IDEXX is responsible for the safety features of its products only if servicing maintenance and modifications have been carried out by IDEXX or by a person expressly authorized for this purpose by IDEXX Like all technical devices the IDEXX DR 1417 system needs proper operation regular maintenance and care as described in this chapter of the Cornerstone Diagnostic Imaging Users Guide If you use the system incorrectly or if you neglect to carry out proper maintenance IDEXX cannot be held responsible for resulting errors da
18. The system may have labels with one or more of the following symbols These symbols indicate the IEC standards to which the system conforms Caution consult accompanying documents Protective earth points Power on O Power off AN Caution electrical shock hazard 199 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 12 5 Labeling Summary External labels atte Sate Ce Soe oe Bi Product data plate back of scanner _ ae Ps oa l Internal safety labels APERTURE LASER APERTURE a Laser emitting product Class 3B laser product inside unit AN High voltage Protective earth point chassis stud 18 12 6 Recycling Symbol In the European Union this symbol indicates that when the last user wishes to discard this product it must be sent to appropriate facilities for recovery and recycling X 200 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 13 Specifications 18 13 1 Scanner Weight lt 79 lb 36 kg Dimensions W x D x H 29 5 X 21 7 x 13 4 75 x 55 x 34 cm Screen type Flexible GP phosphor screen Power consumption in operation 95 W Power consumption while idle 50 W Power consumption while in stand by 50 W Heat dissipation while in operation 324 BTU hour 18 13 2 Storage and Operation Environments Operation Transport Storage Ambient temperature 59 F to 86F 15 C to 30 C 9 F to 150 F 23 C to 66 C Relativ
19. To use mouse shortcuts Hold down the right mouse button and move the mouse up and down to zoom Double right click to return to original zoom image fits in window Chapter 5 Reviewing Images 59 Chapter 5 Reviewing Images Hold down the left mouse button and move the mouse left to right to change the window brightness and up and down to change the level contrast for the image Double left click to return to original window and level Press SHIFT and right click while moving the pointer to magnify an area of the image To activate or deactivate the image enhancement shortcuts 1 2 3 From the menu bar select Controls gt Defaults gt Staff The Staff Defaults window appears Select the Miscellaneous tab Check the Enable keyboard shortcuts box to turn on the shortcuts Uncheck the box to turn off the shortcuts Click Save The Staff Defaults window closes 5 9 Viewing Archived Images When an image is archived it is removed from the database on the computer and stored in your selected archive location e g archive hard drive CD network server etc A thumbnail of the image remains in the patient record as a reference to the image Archived images are labeled as Archived Te Use the Image Explorer to find the archived image For more information see 2 2 About the Image Explorer Double click the thumbnail of an archived image to open it a Ifthe image is readily accessible e g on a
20. agents are used even when used on the patients 20 9 9 Power Cord Safety Information When operating the digital x ray detector a certified detachable power supply cord AN must be used and comply with the following criteria CAUTION To meet applicable U S regulatory agency requirements use the power cord supplied with the IDEXX I Vision DR System which meets the following criteria Cord e Type SJT e Minimum No 18 AWG wire e 3 conductor wire e Rated minimum 10 Amps 125V e Maximum length of 13 ft 4 m Plug e Molded on grounding type attachment plug e Listed Hospital Grade e Either 120V NEMA 5 15P or 240V NEMA 6 15 type 22l Chapter 20 The IDEXX I Vision DR System 20 9 10 Mechanical Safety Information Ensure that the patient is suitably restrained in accordance with accepted standards for administration of treatment 20 10 Caution Regarding Small Detail Object Imaging As with all digital imaging devices there is the potential that small detail structures high contrast edge structures and fine line structures with a repeating pattern could appear differently in the digital image than in an image created with an analog device such as a screen film system or with another digital device having smaller individual detector elements For example for a sharp edged object the edges of that object may appear to have stair step when in fact the object edge does not have such structure This is an
21. and EquiView systems only 1 After you capture an image for an exam type highlight that exam type and right click Select Replace from the pop up menu 2 Take the image Image capture begins and a blue progress bar appears at the top of the computer window The original image is discarded and is replaced by the newly captured image To look at an image you have taken For all systems gt lf you want to look at an image after you have taken one or more other images highlight the exam type and then either double click or right click and select Reload from the pop up menu The image is displayed in the viewer window 134 Chapter 11 Image Coach and Other Tools 11 4 The Plate Handle Locator You can choose to add a plate handle locator marker to your images The plate handle locator marker appears on the image in the corner where the cable attaches to the plate if you are looking at the plate from the front with the handle on the left side this would be the upper left corner This marker appears as two small squares next to each other one black and one white For information on how to turn this feature on or off see 14 4 1 Setting Up the Plate Handle Locator 11 5 Adding a Position Marker to the Image When you capture an image you can add a marker to indicate whether this radiograph is left or right lateral or medial Once you have added a marker to an image the marker is part of the image whenever you view it i
22. and then edit the information e To delete an address click a row and then click Delete Click Save to save and close the System Settings window or click Apply to save without closing the window To set up IDEXX integration technology for telemedicine 1 2 10 11 12 Select Tools gt Settings gt System in the menu bar On the left side of the System Settings window select Telemedicine Provider The Telemedicine provider configuration table appears on the right To add a new provider click Add A new row appears in the table In the Name text box type the name that you want to be displayed for this provider on the Case Detail window Skip the Homepage text box it has been provided to support future functionality In the API URL text box type the Web address you use to reach the telemedicine provider Be sure to start with http or https per the instructions of your telemedicine provider For example you would type https api vetmedstat com VMSIntegrations VMSTMS asm x for IDEXX Telemedicine Consultants In the Login and Password text boxes type the login name and password you use to log into the telemedicine provider s site In the Authentication drop down menu choose the password authentication method that your telemedicine provider specifies Click the row you just entered to select it Click Apply Click Test Tele provider A message will appear telling you whether the connection was succe
23. different appearances an overexposed image may look light in some areas and dark in others 131 Chapter 11 Image Coach and Other Tools Try the following troubleshooting steps 1 Check to be sure that you ve measured the thickness of the anatomy correctly Check that you used the proper technique for this anatomy thickness and view Decrease the kVp by 5 10 or decrease the mAs by two stations Retake the same radiograph OP e ay If the new radiograph is not diagnostic call IDEXX Digital Imaging Support at 1 877 483 9948 If radiographs are consistently nondiagnostic for a particular exam type and the index is consistently high or low gt Contact IDEXX Digital Imaging Support about adjusting your technique chart for that view If radiographs are consistently nondiagnostic for all exam types and the index is consistently high or low gt Ask your generator service technician about getting the generator calibrated After generator recalibration you will need to contact IDEXX Digital Imaging Support to arrange to have a new technique chart created 11 2 Technique Prompt Before you take each radiograph the capture screen can display the recommended technique kVp ABD Right Lat and mAs you should use for that exam type To see recommended technique you need to select either the weight of the patient or the thickness of the body part Fi 5 1 O Note If you re using an IDEXX I Vision DR or IDEXX DR 1417 system your t
24. e g those with a high alcohol content the plastic will be damaged Do not use CAUTION corrosive solvent or abrasive cleaning or polishing agents To clean e Turn off the power and disconnect the power cord before cleaning the device e Make sure that water or other fluids do not get inside the device e Wipe painted parts and aluminum surfaces with a damp cloth and a mild cleaning agent and then wipe with a dry cloth e Wipe chrome parts with a dry cloth only 15 2 2 Disinfecting The IDEXX DR 1417 system must not be subject to a bath disinfection sterilized in an autoclave or put into another device for sterilization The IDEXX DR 1417 CAUTION system can be wiped with a disinfectant The method of disinfection applied must correspond to the applicable legal regulations and guidelines on disinfecting and explosion protection Do not use corrosive solvent or gaSeous 191 Chapter 15 The IDEXX DR 1417 Digital Imaging System disinfectants If you use disinfectants that form an explosive gas mixture they must evaporate first before you turn on the device To disinfect e Turn off the power before disinfecting the device e All parts of the device including accessories and connecting cables must be given only a wiping disinfection e Do not use a spray disinfectant because It can enter the device e lf you use a room disinfectant atomizer turn off the IDEXX DR 1417 system and remove it from the area before using t
25. inches meters centimeters or millimeters b From the Exposure Units drop down list select the default unit for measuring the x ray exposure time AmpSeconds As milliAmpSeconds mAs or microAmpSeconds uAs The DICOM Compression Settings area allows you to selecting the compression type used when you send via DICOM or save images as DICOM dcm files e RAW images are DICOM images that have not been compressed e JPEGLossless images are compressed but have little to no loss of image quality e JPEGBaseline images also called JPEG lossy are compressed and may have some loss of image quality Note In most cases you will not need to change the default setting which is RAW In the Image Export area do the following e f images look considerably different after being sent or saved with DICOM try checking Apply Window Level to Exported Images in the Image Export area This will change the way that window and level contrast and brightness values are saved in DICOM files e If you want images to contain the overlay information displayed in the Image Viewer select Apply Overlays to Exported Images When you begin a print send or save action the Apply Overlay option will be selected for you but you will be able to deselect it if you want e lf you want the images to contain the annotations created in the Image Viewer select Apply Annotations Exported Images When you begin a print send or save action the Apply Annotations
26. select Absolute in the Type text box Enter the window contrast value in the Window text box and the level brightness value in the Level text box To change window and level values relative to the settings in the preset that you are copying select Relative in the Type text box e To increase or decrease values in the Window contrast text box enter percentage values that are greater or less than 100 For instance typing 110 in the Window text box increases the window value by 10 while typing 90 lowers it by 10 e To increase or decrease values in the Level Shift brightness text box type the number that you want to be added to or subtracted from the current level value For instance typing 500 will add 500 to the current level value while typing 500 will subtract 500 Click Save The Presets Configuration Detail dialog box closes and the new preset appears in the list of presets in the Presets Configuration information To edit an existing preset 1 A 3 On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select Presets If you are the Administrator and you want to edit a system preset click the System tab If you want to edit a user preset click the tab with your user name Select a preset and then click Edit The Presets Configuration Detail dialog box appears Change information in the Name and Modality text boxes To change window and level values by
27. system or with another digital device having smaller individual detector elements For example for a sharp edged object the edges of that object may appear to have stair steps when in fact the object edge does not have such structure This is an effect of digital under sampling For small detail objects having a size on the same order of magnitude as an individual pixel or smaller the apparent contrast of that object can vary based on the position relative to the individual detector element locations For example the contrast of a single spherical object the same size as a pixel would have a dramatically different appearance if the object were imaged directly overlying a detector element highest contrast or placed at the intersection of four detector elements lowest contrast Objects inherently smaller than an individual pixel have a radiation intensity signal over an area larger than the small object In each case a lower apparent signal to noise can result in reduced visibility of such objects 179 Chapter 18 The IDEXX Vision CR Digital Imaging system IMPORTANT The instructions in this chapter refer to the IDEXX I Vision CR Digital Imaging System labelled with IDEXX I Vision CR on the front of the scanner If you have an IDEXX CR 1417 or IDEXX CR 1417 model 140 or 140R Digital Imaging System see the appropriate chapter These systems have an oval label on the front of the scanner 18 1 Background The IDEXX I
28. the series or the study 2 3 1 Image i i i 5 I Frorias z Ru taira hia J treapta An image is a single image such as a radiograph or ultrasound An 7 Om ouem amaia Oi Misa image record in Cornerstone may also be a video Sn f eee wa al cs lew Albdoren You can see thumbnails of images on the Image Explorer window 6sm Co Image Abdomen You can see the image itself on the Image Viewer window l l l Te l l Figure 2 4 An image series as seen in the Patient History area of the Patient Clipboard 2 3 2 Series A series is a group of related images Usually all of the images in a series are of the same body part or are taken within the same anatomical region Senes Front Extremity On the Patient Clipboard image series are displayed in the Patient History area as shown in Figure 2 4 Figure 2 5 Images in a series as seen in the Image Explorer On the Image Explorer the header line for each series shows the name of the series and turns from gray to red when the entire series is selected Figure 2 5 shows how images are grouped in a series on the Image Explorer When you open an image in the Image Viewer window the rest of that image s series is also loaded in the Image Viewer If the Thumbnail Pane is open in the Image Viewer it displays the whole series 2 3 3 Study A study is a group of image series that were captured at the same time for the same patient On the Image Explorer window the study name
29. 22 5 2 Creating an Image Request from the Patient Clipboard Manual Method 249 22 5 3 Selecting Image Shots on the Shot Selection Dialog BOX cccccccccccceeeseeseseseeeeeeseeeseeeseeeens 250 22 5 4 Managing Image Requests and ReSullts cccccsssscccceeeecceeccssscnecetsesseeseseseceeeeeesseseeneceasaneees 251 22 5 9 Capturing Images tor a REQUC SI cacc cecnacecwnancitestiamasitenticatnt stisticdcnsticticd E aN ei ia 252 22 5 6 Using the Image Request Special Action Item Report ssssssssssssssssssssssssrrrrrirrrrrrrrrrrrrrrrrrrrrrrrrrn 253 22 5 7 Charging for Not Requested IMageS eeeeesesssessssssererrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrns 254 22 5 8 Manually Setting Requests to a Status of Completed ccccccesscccseesssesssesssentneneseesesseeeess 255 22 6 Image Request Special Action Item Report Filtered by Modality 256 Section 4 IDEXX I Vision Mobile Application ccccsceessesseeeeeeeeeeeneeeeeeeeneeeaeeenneaenensneens 257 Chapter 23 Using the Mobile Application cccssccseseeeeeeeeseeeeeeeeeeeeneeeeeeeeneaeseeenseneaeeeneens 257 MN N e i EAE A E E a operon aenestaeeneeeae 207 Pe PUM MY NV Ol WOW E E sau uses EA E A AN AET Zor 2M Me MING WEA eS AE AE 257 A AE ER DEI E cece cect AE ETET E EE 258 23 23 Regues ng CHO Cel ev sectzes su ancteaspenccenmacae aaa NERE E ia AANER E ERANA EENES 258 23 3 Setting Up the Applicatonon New Tablets srssressre
30. 5 1 Symbols The following symbols are displayed on the relay box mmx Direct current Caution refer to operator s guide 21 5 2 Relay Box Power Source Caution The IDEXX DR relay box requires 5VDC 150mA which is supplied from the DR controller box It is not independently powered Do not substitute other devices or power supplies with this unit 230 Chapter 21 The IDEXX DR Relay Box 21 6 Replacing the IDEXX DR Relay Box If necessary a damaged or defective IDEXX DR Relay Box can be swapped for a replacement Tools needed You ll need a small i flat screwdriver to remove the screws on the connectors and to set the configuration switch To replace a relay box il 2 3 Turn off the generator the computer and the DR controller box Locate the relay box that is currently connected to your system On the back of the box note the position of the Gen Type switch up or down The back of the box is shown below GENERATOR EXPOSURE DR CONTROLLER SS0VAC 4A S0VDC 1 4 GEN TYPE SWITCH BOX PREP EXPOSE ott Puse Using the tip of the screwdriver set the Gen Type switch on the new box to the same position Also on the back of the box unscrew the Exposure Switch and DR Controller Box connectors Be sure to note which is which Unplug the cable that runs to the generator this is attached with a green connector Attach the Exposure Switch DR Controller Box and Generator cables to the proper connectors an
31. 6 General Safety IMMOMMAN ON aicicsnsnitstnitsdnitstinthatinasidtsetidtrstidestidtietidatastiteencedetetnteliegstaatiannpasatennindetatetetetaiietad 160 159 7 Seded Systemi salety MONN ANO cuca cncsaecnangedsssasssasspancsduqunanebensnanebencensshsnatasaasnsdsouscaeauceauceauceaas 160 15 9 8 Electrical Safety IMOMMAL OM iaeiseinininindnsniminlnindltsndeissdeietdeissdeiesialtnstelsnDeteceeteltaabshebadsgamedadanddanedelatetecelacss 161 15 9 9 Power Cord Saleiy IMOrnmMalON seoecneiiiseerisoo sinni EES ERE PEERAA SENNECESE 161 15 9 10 Mechanical Safety ITOK MMAUON siintacritnntnansivasiceasistienseesisne Sennen tecaieate tecattetnesabanataansanagnnntsnbate dete bece deuad 162 15 10 Caution Regarding Small Detail Object Imaging ce cestaiss soe tass onsudvenswaesses wwaeseetaaminiaunmnuniaaiameneceeceaecoots 162 Chapter 16 The IDEXX CR 1417 Digital Imaging System ccesceeseeeeeeeeeeseeeeeeseeeeeseeeees 163 To Ml 121 lt 8 OUN Peete neti ie eae ee eee eee eee eee eee ee eee eee ee 163 16 2 The IDEXXCGR 1417 System Scanner aicccatcectonutcaucrastascctasnstsccasaselenieeuesty cel geet EE Err EEr KESKE EEANN 164 16 2 1 Reader Status INAICATOTS sessin ataa aaa a a aa aa aaa a E E E 164 eatae EEE VIC E E EE 166 16 4 IDEXX CR 1417 Imaging CaSSettes ccccccccccscseseseseseseeeseesessssessesssseessssseseeeseeeeeeeeeeeseisesseeeeseeeeeaees 166 Eo c glalletel ie PE CANON eeen EE EEEE 166 166 oaei IOI ASN Oieee a EEE AREE EENE iinet nr arate Sata
32. Actions check box See 22 4 3 Setting Up Invoice Items to Initiate Image Request Special Actions to set up special actions for invoice items Whenever you add one of those invoice items to the Patient Visit List 245 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration PVL or invoice for a patient Cornerstone will automatically start the work flow to create a new image request Note This feature is automatically selected when imaging integration is activated PP Prectice and Workstation Defaults Becca Imaging 4 Select Use billing staff on new image request if you want the person listed as Blep ity E ear billing staff member on the PVL or invoice to be associated with image requests socom se created via special actions If this check box is not selected the last staff member oo gatene m who created an image request on that computer will be associated with the cari nee image request inte ERC ae Bali Hil tr reper ree cpap 5 select options under Staff to use on request without Special Action to specify who will be associated with manually created image requests Shae in vine on ragana vahat Spei Martine a Select No default staff if you want to select a staff member when you create an image request b Select Last staff used on workstation if you want the last staff member who was associated with an image request on this workstation to be associated with a ne
33. CBee e Sin i ay P Ss aj begh Tiar rer Fie lee Cpr Figure 5 4 Adding an image to the Workspace TIP You might want to compare images from different animals in order to compare a current patient with a past patient who presented with the same condition To make it easier to find past images that are good examples of certain conditions you can set up keywords for those images See 5 13 Editing Image Details for more information select the image or images you want and either right click and select Add to Workspace or click Add to Workspace Copies of the thumbnails appear in the Workspace area at the bottom of the Image Explorer window If you want to add images from more patients repeat steps 3 and 4 57 Chapter 5 Reviewing Images 6 When the Workspace area contains thumbnails for all the images you want to compare hold down the CTRL key and click the thumbnails of the images that you want to compare If you want to select all of the images in the Workspace area click Select All Note that four images is the maximum you can compare at one time 7 Click Compare The images you selected are displayed together in the Image Viewer 5 5 1 Comparing the Current Version of an Image to the Original This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software starti
34. CD separately from the patient CD viewer and can be accessed through the Windows operating system 36 Chapter 4 Cases and Telemedicine 4 7 Sending a Case to a Telemedicine Provider with IDEXX Integration Technology Before you use this feature you need to set up the Web address es to which you want to connect See 8 11 Setting Up Remote Consult and IDEXX Integration Technology for Telemedicine To submit a case to a telemedicine provider 1 Starting on either the Image Explorer or Image Viewer window create a case that includes the images you wish to submit to the telemedicine provider See 4 2 Creating Cases On the Case Detail window expand the Thumbnails pane if it is not already open If you want to attach supporting material do the following a Click Attach File The Open dialog box appears b Select the file s you want to add and click Open c Repeat these steps if you want to attach additional files If you want to attach additional images do the following a Click Add Image A small version of the Image Explorer window appears displaying thumbnail images for this patient b Click the image you wish to add or hold down the CTRL key and select multiple images c Click Select Image The images are added to the case If you want to remove an attachment or image select its thumbnail and click Remove Expand the Case Actions pane Select the tab for the telemedicine provider you want
35. Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select Presets 3 lf you want to create a new system preset click the System tab If you want to create a new user preset click the tab with your user name Click New The Presets Configuration Detail dialog box appears Type a name for this preset in the Name text box 6 Inthe Modality drop down list select the type of device used to capture the images to which this preset will be applied 7 To change window and level values by specifying exact values select Absolute in the Type text box Enter the window contrast value in the Window text box and the level brightness value in the Level text box TIP Only the Administrator can copy a system preset directly If you want to create a new preset based on an existing system preset and you are not the Administrator do the following 8 lo raise window and level values relative to their current settings select Relative in the Type text box e Jo increase or decrease values in the Window contrast text box enter percentage values that are greater or less than 100 For instance typing 110 in the Window text box increases the window value by 10 while typing 90 lowers it by 10 1 Inthe Image Viewer apply the system preset to an image see the instructions in 5 11 2 Applying a Window Level e To increase or decrease values in the Level Shift brightness text box type the number that yo
36. Dimensions of the laptop case Figure 19 7 Dimensions of the box computer 208 Chapter 19 The IDEXX EquiView Digital Imaging System Hard disks 160 GB internal 160 GB external Drive DVD CD 8X DVD RW Monitor 14 1 1280 x 800 Gigabit Ethernet Operating system Microsoft Windows XP Professional Digital x ray plate dimensions Length 37 7 cm 14 84 Width 32 7 cm 12 9 Height 2 2 cm 0 9 Weight 3 2 kg 7 Ib Location Mobile portable unit Active area 20 cm x 25 cm 8 x 10 19 8 2 Electrical Data Computer Power supply 100V 240V AC 10 50 60 Hz X ray plate transport and storage case Power supply 100V 240V AC 10 50 60 Hz 75 WH power consumption or 12V DC using the car jack 3 Amps power required CAUTION Do not leave the x ray plate transport and storage case connected to a vehicle electrical system for more than 12 hours doing so may drain the battery 19 8 3 Computer Specifications Rugged box version CPU 2 4 GHz 512 KB cache 400 MHz system bus Memory SDRAM 1024 MB Video card 128 MB 209 Chapter 19 The IDEXX EquiView Digital Imaging System Hard disk 2 x 180 GB total 360 GB 7200 rom EIDE UATA Drive DVD RW CD RW combo drive Monitor 15 1 1024 x 768 TFT monitor Gigabit LAN Operating system Windows XP Professional Laptop version CPU 2 0 GHz Memory SDRAM 2 GB Integrated Graphics Media accelerator Hard disks 160 GB internal 160 GB
37. F 10 C to 35 C Relative air humidity 20 to 75 RH noncondensing Max rate of change lt 18 F 10 C per hour Pressure range 500 to 1060 hPa Note The IDEXX DR 1417 system must not be operated in conditions under which condensation can form in the device Operate the device only under the environmental conditions described above Storage Environment Temperature 50 F to 104 F 5 C to 40 C Relative air humidity 5 to 95 RH noncondensing Max rate of change lt 27 F 15 C per hour Pressure range 500 to 1060 hPa Transit Environment Temperature detector plate 50 F to 95 F 5 C to 40 C Temperature black box 40 F to 45 F 40 C to 45 C Humidity 5 to 95 RH noncondensing Max rate of change lt 27 F 15 C per hour 15 9 Safety Information 15 9 1 Safety Statement The user s guide is an integral part of the IDEXX DR 1417 system Keep it close to the system for ready reference Observance of the instructions contained in the user s guide is a precondition for the use of the system for the intended purpose and for its correct operation The system may be operated only by personnel who have the necessary knowledge and have been instructed in its use Operator safety and trouble free operation of the system are only ensured if use is made of original equipment parts Moreover only those accessories may be used that are specified herein or that have been expressly approved and released by IDEXX
38. Figure 11 1 Positioning photograph and text positioning along with recommended beam center measurement point and other variables as well as other hints for obtaining the best quality radiograph of that view Ff Position 11 1 2 Reference Radiographs Before or after you take a radiograph you can see a reference image that shows how a radiograph should look when the patient is positioned properly for this view To display a reference radiograph before you capture p Reference cee An image appears showing an example of how a radiograph should look for the selected view This radiograph is provided to assist in taking the radiograph correctly not as an example of any particular pathology gt Onthe right side of the Image Capture window click Reference Figure 11 2 Reference radiograph 130 Chapter 11 Image Coach and Other Tools To compare a radiograph to the reference radiograph gt At the top of the Image Capture window click Compare to Reference appears on the left and the reference radiograph appears on the right Your radiograph 11 1 3 Exposure Index After you capture a radiograph a scale on the Image Capture window displays the level of x ray exposure This exposure index shows whether the proper amount of x rays to produce a diagnostic image reached the detector or screen or whether the image was improperly exposed Key things to remember about the exposure index e Trust the
39. IDEXX SmartLink Digital imaging and Modality Worklist Integration First create a service type invoice item called Radiograph 2 view Thorax 0 20 SM for 165 00 On the Spec Actions tab choose Image Request then click on the Shot Selection E icon Open the tree to Small animal less than 20 lbs and Thorax Routine and select both THX Lat and THX VD Create another service item called Radiograph 2 view Thorax 20 40 M for 175 00 Go into the Spec Actions tab and choose Image Request then click Shot Selection E This time open the tree to Medium animal 20 40 Ibs and Thorax Routine and select THX Lat and THX VD Finally create a third service item called Radiograph 2 view Thorax gt 40 LG for 185 00 Go into the Spec Actions tab and choose Image Request then click on Shot Selection Be and open the tree to Larger animal greater than 40 Ibs and Thorax Routine and select THX Lat and THX VD Now create a Group item called Radiograph Thorax 2 View Enter the three service items you created in the steps above and mark each of them as Smart Enter the weights indicated on each item s description e For Radiograph 2 view Thorax 0 20 SM select Only pets with weights and enter 0 through 20 Ibs e For Radiograph 2 view Thorax 20 40 M select Only pets with weights and enter 21 through 40 Ibs e For Radiograph 2 view Thorax gt 40 LG select Only pets with weights and enter 41 through 200 Ibs
40. Image Explorer window or the Imaging Dashboard window To set up single species mode 1 On the Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Global Settings 3 Inthe Set Single Species Mode drop down list select the species you want 4 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 149 Chapter 14 Setting Up IDEXX Digital Imaging System Features 14 5 Setting Up System Type The System Type options are used to select the IDEXX Digital Imaging system you are using when the system is first installed DO NOT change any of the system type options without consulting IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 14 6 Entering Values to Set Up the Technique Prompt To set up technique prompt values 1 2 On the menu bar select Controls gt Defaults gt Imaging The System Settings window appears On the left click Exam Trees and then click Capture technique chart The header row for a table of technique chart values appears IMPORTANT Do not change any other settings related to the exam tree without consulting IDEXX Digital Imaging Support In the Unit of Measurement drop down menu select the unit you use to measure patient weight or thickness of the body part to be radiographed Click Add A blank row appears in the table In the Measurement
41. Imaging module purchased with earlier versions of Cornerstone software 67 Chapter 5 Reviewing Images When you view dental radiographs specialized dental viewing modes are available on the Image Viewer window These modes allow you to arrange images in a variety of dental layouts and to move back and forth among them The layouts facilitate the following e Viewing the whole series in a template layout e Viewing all the images from the template layout in a grid e Viewing selected images in isolation at a larger size Note The Image Viewer uses dental image viewing modes whenever it detects images that were captured with the DICOM modality of Intra oral Radiography IO 5 15 1 Template Mode Every radiograph in the series is shown on the Image Viewer window In template mode the primary radiographs for the series are displayed in the template pane and arranged in a template layout so that you can view the radiographs in relation to one another The rest of the images in the series are displayed in the overflow pane at the bottom of the screen Pier Vee fe fee Pe bee bees Template pane a An empty cell Overflow pane _ a Last overflow cell Figure 5 9 Template mode showing dental radiographs displayed in the Full Mouth 18 template layout The positions where radiographs can be placed are called cells and are shown as black rectangles In order to customize the way you view a particular seri
42. New and create the request using the options on the New Image Request dialog box e Jo update an image request with a status of Requested Partial or Not Requested select the request and click Update Depending on the status of the request different updating options are available e To delete an image request with a status of Requested select the request and click Delete e To view images for a request with a status of Completed Partial or Not Requested select the request and click View Images Ihe image or images associated with the request open in the Image Viewer e If you have SmartLink Digital Imaging to capture images for a request with a status of Requested or Partial select the request and click Capture Images Note The Capture Images button is enabled only when using an IDEXX DR or IDEXX CR capture workstation e To view the most current information in the Image Requests list click Refresh When you are finished click Close 22 5 5 Capturing Images for a Request If you have an IDEXX Digital Imaging system once you have created an imaging request Cornerstone allows you to keep track of the exam types shots you have selected and to make certain that you capture the right images 252 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration To select a request and capture images 1 Onthe Image Request and Results screen select a request and click Capture Images Note You can als
43. Not Requested shots See 22 5 7 Charging for Not Requested Images If you do not preselect specific views on the Image Request and Results window You have more freedom in situations where the exact shots are not known at the time of the request You need to use the exam description to communicate to the technician about the shots that should be taken for the request A request with no specific shots selected will NOT produce any Not Requested image results Cornerstone will count any shots taken during the capture session as part of the request How it works preselected views version ie Add an imaging item to the Patient Visit List PVL or invoice for a patient The New Image Request dialog box appears Verify image request details i e staff amount etc and make changes if necessary Click the Shot Selection icon and select the desired shots Click OK on the New Image Request dialog box The charge is automatically recorded on the INVOICE On the PVL change the imaging item description so that it s more descriptive for the client e g 2 Views Abdomen When ready to begin the image capture process select this request on the Image Requests and Results window and click Capture Images The shots are preselected on the Capture Setup window How it works views not preselected version 1 Add an imaging item to the Patient Visit List PVL or invoice for a patient The New Image Request
44. Process without a Capture Request The following procedure can be used whether or not you have IDEXX SmartLink Digital Imaging The captured images are returned to Cornerstone and are matched to the patient record If you are not using IDEXX SmartLink Digital Imaging you must add the charges to the invoice manually If you have IDEXX SmartLink Digital Imaging images that you capture without a Choose Exam Type request will have a status of Not Requested See 22 5 7 Charging for Not Requested Images OBS Medium Animal Cie to dots CE Larger Animal greater than 406s To start from the Patient Clipboard Image Explorer or Imaging Dashboard 1 On the Patient Clipboard right click anywhere in the Patient History area and select Image Capture OR On either the Imaging Dashboard window or the Image Explorer window a Click Capture Images The Select Client and Patient dialog box appears Figure 10 2 At first only the highest level groups are shown b Type information in one or more of the search fields and click Search c Click the patient name to highlight it and then click Select at the bottom of the dialog box 2 lf your user name does not appear in the Technician text box at the top of the Capture Setup window select it from the drop down list peice ag 3 Inthe Veterinarian text box select the name of the veterinarian for whom you are capturing the images 4 From the Choose Exam Type area click the plus
45. Range text box type a thickness range in centimeters In the kVp and mAs text boxes for each anatomical region type the values from your technique chart Note The software will extrapolate from these three general region settings in order to display technique values for all exam types To enter values for another anatomical thickness click the Add button and repeat steps 5 and 6 To delete a row click in the row to select it and then click Delete Click Save to save and close the System Settings window Click Close in the upper right of the Cornerstone window to close the software and then open the software again for the changes to be applied 150 Chapter 15 The IDEXX DR 1417 Digital Imaging system 15 1 Background The IDEXX DR 1417 Digital Imaging System uses a direct energy conversion process with a selenium detector plate X rays are directly converted into an electrical signal without a light conversion layer By effectively eliminating the light diffusion present in indirect technology the IDEXX DR 1417 system provides a sharper more detailed image The IDEXX DR 1417 system provides a digital image capture capability for conventional radiographic examinations The system may be used wherever traditional x ray screen film cassettes are used Follow all safety labels on the equipment 15 2 Cleaning and Maintenance 15 2 1 Cleaning Plastic surfaces must be cleaned only with a soap solution If you use other agents AN
46. Restores image to original state Opens image sharing tools email DICOM telemedicine Chapter 23 Using the IDEXX I Vision Mobile Application 265 Gestures Pinch spread to zoom out in Double tap to fill screen width Open window level tool then drag horizontally for contrast or vertically for brightness Drag horizontally with two fingers to flip horizontally Drag vertically to flip vertically Drag forefinger in a circle around thumb to rotate Drag horizontally with one finger to move image Flick left right to view previous next radiographs Chapter 23 Using the IDEXX I Vision Mobile Application 266 Chapter 23 Using the IDEXX I Vision Mobile Application 23 4 4 Viewer Dolphin Browser Top of screen v j Reveal hide enhancement tools Bottom of screen wv Reveal hide thumbnails Tap thumbnail to view or tap arrows ef View previous next radiograph in series Figure 23 3 The Viewer screen Dolphin browser Gestures Back to Patient Summary Reverse light and dark Pinch spread to zoom out in Revert to image as originally displayed Send via DICOM R clockwise icine otate 90 clockwise send to telemedicine amp Flick left right to aiia A amp view previous next Tap a new setting on the slide bars window brightness on vertical level contrast on horizontal Email i radiograph 267 Chapter 23 Us
47. Signal Output Connection Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC standards i e IEC 60950 for data processing equipment and IEC 60601 1 for medical equipment Furthermore all configurations shall comply with the system standard IEC 60601 1 1 Everybody who connects additional equipment to the signal input part or signal output part configures a medical system and is therefore responsible that the system complies with the requirements of IEC 60601 1 1 If in doubt contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 159 Chapter 15 The IDEXX DR 1417 Digital Imaging System 15 9 5 FCC Class A Verification Information to the user This equipment has been tested and found to comply with the limits for a Class A Digital Device pursuant to part 15 of the FCC Rules These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with this User s Guide may cause harmful interference to radio communications Operation of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense 15 9 6 General Safety Informati
48. The image might need to be adjusted due to differences in collimation and variations in exposure and size Use the Window Level tool to tune your images before clicking the Done Capture button The window of an image indicates how much contrast will be in the image A small window between 500 and 2000 will show high contrast but some bone or lung detail may appear washed out and be difficult to see With a very large window around 5 000 or 10 000 an image will be flat and very evenly gray The level sets the center point where the image changes from white to black similar to the brightness adjustment on a TV Changing the level makes the overall image lighter or darker and allows you to see detail in different areas of the image For most images the level will average around 8000 139 Chapter 12 Checking and Approving Images The most frequent use of the Window Level tool is to adjust the window down to provide a high contrast image and to move the level up and down to view different areas for example to go from the lungs to the abdomen in the same image You can adjust the window and level by hand with the Window Level tool or automatically with the Presets tool To use the Window Level tool The Window and Level settings are displayed to the right of the tool bar Click the Window Level tool oO and click and drag the cursor e Left to right to increase the window e Right to left to decrease the window e Bottom t
49. Vision CR system scanner uses a phosphor screen with energy storage capability as an x ray image receptor The imaging screen is contained inside a cassette Three sizes of cassettes can be used with the scanner 14 x 17 inches 10 x 12 Inches and 8 x 10 Inches When the x ray exposure is made the phosphor storage screen is charged with a latent image of the x ray shadow from the anatomy imaged Soon after exposure the cassette is loaded into the scanner The screen is extracted by the scanner Within the scanner a laser beam scans the screen stimulating a faint blue light proportional to the x ray exposure This blue light response is collected converted to an electrical signal and digitized The digital image data is then passed on for digital image processing The screen is erased with light and returned to the cassette so that it is ready for the next image capture Note The only time a screen is out of the cassette is when the IDEXX I Vision CR system scanner automatically loads the screen for scanning The IDEXX Cornerstone Practice Management System is designed for use with the IDEXX I Vision CR system scanner Knowledge of basic computer functions is required to operate the software and scanner 180 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 2 The IDEXX I Vision CR Scanner Your IDEXX representative will set up your IDEXX I Vision CR system scanner for you However you need to be familiar with the var
50. a study by typing the number of rows and columns in the text boxes e inthe Series Layout area set up how individual images are displayed within a series by typing the number of rows and columns in the text boxes e if you want to display images in s stacked display click Stacked 4 Click Save to save and close the dialog box or click Apply to save without closing the window Chapter 5 Reviewing Images 48 Chapter 5 Reviewing Images The Edit Overlays tool is used to select the information that you would like to display in the image overlays When you click this tool a table appears that allows you to specify how each piece of information is displayed in the overlays e n the Display column check or uncheck the box to display or hide each piece of information e Inthe Grouping column use the drop down list to select the area of the window where you want this piece of information to be displayed e n the Order column use the drop down list to specify where this piece of information will appear within a line e Inthe Line Number column type the line number within this grouping where you want to display this piece of information The Edit Series Layout tool allows you to specify the way that the images within a series are displayed This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone softw
51. adjust the window down to provide a high contrast image and to move the level up and down to view different areas for example to go from the lungs to the abdomen in the same image You can adjust the window and level by hand with the Window Level tool or automatically with the Window Level Presets tool 5 11 2 Applying a Window Level Preset When you apply a window level preset to an image in the Image Viewer the window and level values for that image change to the preset values To Apply a Window Level Preset gt Click the Window Level Presets tool os and select the preset that you want to use The window and level values for the image are changed 5 11 3 Creating a New Preset from the Image Viewer In the Image Viewer you can create a new window level preset based on the window level values that are currently applied to the image that you are viewing To Create a New Preset 1 Click the Window Level Presets tool and select New from the bottom of the drop down menu The Presets Detail Configuration dialog box appears 2 Inthe Name text box replace the placeholder text with a name that is more meaningful If you want to change window and level values by specifying exact values select Absolute in the Type text box Enter the window contrast value in the Window text box and the Level brightness value in the Level text box 63 Chapter 5 Reviewing Images 4 lf you want to change window and level values relative
52. air oxygen or nitrous oxide The Detector Panel must not be carried by its connecting cable Note Follow all safety labels on the equipment 214 Chapter 19 The IDEXX EquiView Digital Imaging System 19 10 6 Sealed System Safety Information The detector panel is sealed so that biological fluids will not penetrate the outer casing during normal use The exterior of the plate carbon panel can be cleaned with common decontamination solutions including 20 chlorine bleach solution 1 part bleach to 4 parts water A 5 gluteraldehyde or 70 alcohol solution can also be used To apply the cleaning solution power down the system and disconnect from power source moisten a cloth with the solution and wipe the panel Note The user must follow standard cleaning and decontamination policies and procedures Do not spray cleaning solution directly onto the panel Instead moisten a AN cloth with the solution and wipe the panel i CAUTION E9 Do not immerse the panel in liquid Do not autoclave the panel CAUTION 19 10 7 Electrical Safety Information DO NOT OPERATE THE EQUIVIEW SYSTEM UNDER THE FOLLOWING AN CONDITIONS ici Do not operate the system in potentially explosive atmospheres e Do not operate the system in the presence of potentially explosive gas mixtures such as those that can form when cleaning agents disinfectants flammable anesthetic material skin cleaners oxygen and some coupling agents are used even when us
53. appears Note Depending on when your system was installed your password may being with a lowercase i The Password text box is case sensitive so be sure to make a note of your exact password Insert the cleaning tray by pushing gently until it locks into place Remove the protective paper from the cleaning plate to expose the adhesive Save the protective paper for later 7 Place the cleaning plate on the tray Make sure the cleaning plate is placed in the correct direction as specified on the plate In the Maintenance area click Dismiss and then click OK to reset the cleaning reminder 9 Click Prepare The rollers begin to rotate The System is ready for roller cleaning message Figure 17 12 Inserting the cleaning plate appears 10 Click OK 177 11 12 13 14 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System While holding on to the plate push the plate very slightly into the scanner and let go IMPORTANT Let go of the cleaning plate as soon as the rollers begin to pull it in Resisting the rollers will damage the scanner The rollers pull the plate in almost entirely with a few inches of the plate remaining outside and then feed the plate back out When the plate has been ejected the cleaning tray unlocks Repeat the cleaning process steps 7 9 11 two more times Be sure the cleaning tray is locked in place before you start each cleaning cycle After the t
54. are imaging must match the exam type that is highlighted The exam type that is selected in the shot tree determines image processing values and the image orientation WARNING Do not run other programs while you are using Cornerstone to capture images Running other programs during the capture process may result in loss of data 2 Use the technique chart that was provided by your installer to select suitable settings on your x ray equipment for exposure time and kVp Position the animal on the table 4 Prep the x ray switch You will see a message that the system is prepping At this point the detector plate is ready Chapter 10 Capturing Images 121 Chapter 10 Capturing Images Note Other signs that the system is prepped include e The light on the small black switch box turns from green to red e The green light on the white interface box is illuminated e The x ray generator tube makes the sounds that it usually makes when preparing to fire Press the switch all the way to capture the image Note To ensure the best image quality take your image within 10 seconds of the system prepped message I f more than 10 seconds elapse release the switch and re prep IMPORTANT When taking an image do not perform any other operation on your computer for example printing or entering data You will see a message that the image is being captured This lets you know that the x ray generator has fired The x ray generator makes its
55. are sent JPEG and TIFF formats can be viewed by most Internet browsers and many graphics programs the DICOM format can be viewed only by specialized medical or veterinary imaging software like Cornerstone DICOM Imaging If you choose to send a DICOM file by default the software sends the original version of the radiograph as it looked when you clicked Done Capture at the end of the capture process or when you imported or received the file Changes made on the Image Viewer window such as annotations and window level adjustments are not part of the DICOM image that is sent If you want to send the current version of the DICOM image rather than the original version contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Note You need to set up your system s email defaults before you can email images See 8 4 Setting Up Imaging Email To email images series or studies from the Image Explorer window 1 On the Patient Clipboard in the Patient History area right click the image series and select Image Explorer 2 Inthe Image Explorer select the images you want to send and then click the Email button or right click one of the selected items and select Email from the menu T9 9 Chapter 6 Distributing Images and Using DICOM Do the following e Select Image to create a case with only the images you have selected e Select Series to create a case with the series to whi
56. can change pricing for image shots select the desired Allow change option on the Invoice Item Information window s Info tab for the item For example you can select Only increases which allows the price to be increased but never decreased except by a user with administrator security privileges See the Cornerstone Administrator s Manual or the Cornerstone Help system for more information on the Allow change options 22 5 Using Imaging Integration 22 5 1 Creating an Image Request When entering charges Special Action Method With the Image Request special action available in Cornerstone 8 2 or later invoice items set up to initiate the Image Request special action will activate the New Image Request dialog box when the item is added to the Patient Visit List PVL or invoice for a patient Note In order to create an image request using the special action method SmartLink Digital Imaging must be activated and the Use special actions option must be enabled in Controls gt Defaults gt Practice and Workstation gt Imaging In addition your imaging invoice items must be set up to initiate the Image Request special action To create an image request during invoicing basic steps 1 Add an imaging invoice item to the PVL or invoice for a patient The New Image Request dialog box appears 2 Enter the ID of the staff member responsible for the image requests by typing the ID or selecting the staff from the drop down list For IDEXX Sm
57. case is deleted To update case information 1 a 3 On the Case Detail window if the Case Information pane is not open click Expand gt gt In the Case Title text box tyoe a name for this case In the Staff User drop down list select the staff member or Cornerstone software user associated with this case In the Case Categories list select a category that you want to assign to this case If you want to select more than one category hold down the CTRL key while you select the categories Note You can use case categories when using the Advanced Search tab on the Image Explorer Window If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter 30 Chapter 4 Cases and Telemedicine To add a specialist s comments to a case 1 When the specialist returns his her interpretation of the case select the comments to include in the patient s record and press CTRL C 2 On the Image Explorer window select the Advanced Search tab and make sure that the Cases check box is selected 3 Search for the patient When Cornerstone returns search results the cases for this patient are shown in the Summary List area on the left Cases are marked with a case Icon Double click the icon for the case you want to open The Case Detail window appears On the Case Detail window if the Case Information pane is not open click Expand gt gt
58. click OK to reset the cleaning reminder Figure 18 11 The notched end of the tray goes into the scanner The smooth side should be up providing a clear path from one end of the tray to the other Figure 18 12 Removing the protective paper 10 Click Prepare The rollers begin to rotate 11 Figure 18 13 IMPORTANT Let go of the plate as Click OK to clear any messages that appear soon as the rollers begin to pull it in Resisting the rollers will damage the scanner 109 12 13 14 15 Chapter 18 The IDEXX I Vision CR Digital Imaging System Push the cleaning plate very slightly into the scanner and let go The rollers pull the plate in almost entirely then feed the plate back out When the plate is ejected the cleaning tray unlocks Repeat steps 10 12 two more times Be sure the cleaning tray is locked in place before you start each cleaning cycle After the third cleaning cycle remove the plate and tray Cover adhesive area on the cleaning plate with the protective paper wax side down Store plate in the protective envelope Click OK to close the User window 18 6 Safety Information For your protection and for the protection of the equipment use the IDEXX I Vision CR system scanner only in the manner outlined in this operator s guide The Certification and Identification Label shown in figure 18 11 is permanently affixed to the rear panel of the IDEXX I Vision CR system scanner lf th
59. click Search The Capture Setup window appears Select any exam type in the Choose Exam Type area and click Next The Image Capture window appears Click Capture Image The scanner interface window appears Click Erase When the erasure process is finished the scanner ejects the cassette Click Exit to close the scanner interface window Click Done Capture to close the Image Capture window No image is saved 17 4 5 Cleaning and Handling a Cassette IMPORTANT The cassette will be damaged if it is dropped A dropped cassette will not work in the scanner and is not covered under warranty To keep the cassette free of dust and debris wipe the cassette exterior with a cloth and a mild general purpose cleaner 17 4 6 Cleaning an Image Screen Periodically the imaging screen should be removed from the cassette and cleaned If you begin to see artifacts such as white specks on images the screen may need cleaning Follow these guidelines Never touch the top surface of the screen with your bare hand Always wear gloves when removing and cleaning the imaging screen Clean latex or nitrile gloves may be used The screen is very flexible Handle with care Hold screen by the edges and by the back side The side that faces away from the x ray tubes Wipe the screen with a clean nonabrasive lint free cloth and screen cleaning solution Take care not to scratch the active surface during cleaning 174 Chapter 17 The IDEXX CR 1417 M
60. click and select Add to Case The Select Images dialog box appears Do the following e Select Study to add the study to which the images belong e Select Series to add the series to which the images belong e Select Image to add only the images you have selected Note For more information about image series and study see 2 3 About Image Series and Study 2 Click Select The Select Case dialog box appears In the Select Case drop down list select the case to which you want to add the images Click OK The Case Detail window appears and the information in the Case Details and Thumbnails area reflects the additional images If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter To add Cornerstone images to a case from the Image Viewer Images can be added to cases if necessary Updated cases can be resent to a independent radiologist or telemedicine service for repeat consultations 1 To select the image that you want to add to a case click the image thumbnail in the thumbnail pane so that red borders are displayed around the thumbnail Right click the thumbnail and select Send to from the menu In the Select Action area of the Select Images dialog box select Add to Case In the Select Image Level area select whether you want to add just this image to the case add the whole series to which the image belongs
61. corner of the computer screen Click this balloon and select the option to open the IDEXX Media Write Utility e For every subsequent CD you create an icon for the IDEXX Media Write Utility appears at the bottom of the screen Click the icon to open the IDEXX Media Write Utility to view progress 3 Click OK to close the Message dialog box When the process is complete the finished CD is ejected automatically Note Once you create a CD you cannot add to or change the information on the CD 83 Chapter 7 Other Tools and lasks 7 1 Saving Images Images can be saved in different file formats to be imported into other software programs or to be sent over the Internet The IDEXX Cornerstone Practice Management System can save files in the following formats bitmap JPEG JPEG 2000 TIFF DICOM and several types of video files To save an image 1 2 Do one of the following e On the Patient Clipboard double click the desired image series double click the thumbnail for the individual image to display it in the main window click Save and select Save As from the drop down menu e On the Image Viewer window double click the thumbnail for the desired image to display it in the main window click Save B and select Save As from the drop down menu e On the Image Explorer window right click the thumbnail for the desired image and select Save As from the drop down menu In the Save As dialog box enter a name for the ima
62. e Select Image to create a case with only the images you have selected e Select Series to create a case with the series to which the selected images belong e Select Study to create a case with the study to which the selected images belong e Select Apply Annotations if you want the images to contain the annotations created in the Image Viewer e Select Apply Overlays if you want the images to contain the overlay information displayed Figure 6 1 The DICOM Print dialog box in the Image Viewer Note For more information about image series and study see 2 3 About Image Series and Study For more information about applying overlays and annotations see 6 6 Applying Annotations and Overlays T2 oS a oS a 10 11 12 Chapter 6 Distributing Images and Using DICOM Click Select The DICOM Print dialog box appears select the DICOM printer you want to use from the Printer drop down list Specify the number of copies you want to print Select All Images to print all images or select Key Images Only to print only key images Click Reorder Images to display the dialog box containing the Reorder Images table a Click the Up and Down buttons to move the selected images into the order in which you want them to print b Click Close when you are finished ADCOM Prini Select Print to print the images now or select Add to Batch Print to add the images to the print batch queue for later printing
63. ean fe Type the name or press F2 and use the Client E en List dialog box to choose the client all w abarcas H imapa Captures 2 Letwon Source Mod ality RS arid ee a i Patient ID lype the ID or Press Pe and Local aI 5 R ETTAN indude hiiia baitia Fate use the Patient List dialog box to choose the Cocker Workstation Gao al ii ali F Maury Ibe aia de patient x aM Patient Name lype the patient name or Figure 2 2 The Advanced Search tab press F2 and use the Patient List dialog box to choose the patient Species Select a species from the drop down list Keywords and Categories Select image keywords and case categories from the list Date Select a time period Start and End Type the start and end dates of a time period to search or select the dates using the drop down calendars Location Select a remote computer to search For more information see 3 2 Using DICOM Query and Retrieve to Import Images from Remote Servers Source Modality Select the type of device used to capture the images Doctor Select the name of the veterinarian for whom the image was taken Workstation Select the name of the computer used to capture the image 15 Chapter 2 Program Basics 2 Ifyou want your search results to include images you have captured or imported check the Image Captures check box 3 lf you want your search results to include imaging cases you have created check the Cases check box 4 Ifyou
64. equipment into an outlet on a circuit different from that to which the other device s are connected e Contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Classification 1 Class equipment 2 Ordinary equipment 3 Equipment not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide 4 Continuous operation 212 Chapter 19 The IDEXX EquiView Digital Imaging System 19 10 3 Safety Symbols The following safety related symbol is found in this manual To avoid injury learn to recognize tt j Attention Read the CAUTION or WARNING statement that follows The following safety related symbols are found on the EquiView system components To avoid injury learn to recognize them Power on Power off Operating temperature range Exposure to temperatures outside of this range could damage equipment or affect performance Pt 38 O 28 I Fragile Handle with care Special cleaning instructions See 19 10 6 Sealed System Safety Information Do not immerse in liquids No field serviceable component inside Do not attempt to open the case Control box main power fuse 250V AC 2 Amps Type T 1 OR rae se To identify any terminal that is intended for connection to an external conductor for protection against electric shock in case of a fault or the terminal of a protective earth ground electrode
65. feature allows you to use the search area on the Image Explorer window to search for image studies on remote servers and then import those studies to your local server so that you can review them with Cornerstone To set up a remote server see 8 3 3 Defining Remote Server Configurations To Import an Image from a Remote Server 1 Inthe Image Explorer select the Advanced Search tab then select a remote server from the drop down menu in the Location text box 2 Type search criteria in the other search text boxes and click Search The search results are displayed in a table in the lower part of the window Note Search text boxes that are not supported by the DICOM standard such as Keywords and Categories have been deactivated When you are searching on a remote server you must type search criteria in at least one text box 3 Select the study or studies that you want to import and click Retrieve A message box appears to notify you that the study has been requested Click OK to close the box 4 lf you want to check the status of the study select Activities gt DICOM Queue in the menu bar at the top of Cornerstone window 5 lo find the study after it has been imported select Clear then select Local in the Location drop down menu Use the search text boxes to search for the study 3 3 Using the DICOM Drop Folder to Import Images Automatically If you frequently import a number of DICOM images at one time into Cornerston
66. image If the radiograph is of diagnostic quality don t worry about an exposure index reading that is a little high or low The Normal area on the index is not an absolute goal Figure 11 3 Comparing radiograph to reference e The exposure index is a relative measurement tt is calculated differently for each exam type e The exposure index is primarily meant to provide troubleshooting information for nondiagnostic Ts radiographs For example if you have an all white or all black image a high or low exposure index reading is a valuable piece of information to have when discussing solutions with IDEXX Digital Imaging Support Exposure Normal Figure 11 4 The exposure index For nondiagnostic radiographs where the exposure index is low underexposed Low exposure Can cause graininess a mottled appearance or large amounts of visual noise Try the following troubleshooting steps 1 Check to be sure that you ve measured the thickness of the anatomy correctly 2 Check that you used the proper technique for this anatomy thickness and view and that you selected the correct exam type 3 Increase your mAs by one generator setting Retake the same radiograph lf the new radiograph is not diagnostic call IDEXX Digital Imaging Support at 1 877 433 9948 For nondiagnostic radiographs where the exposure index is high overexposed Overexposed images generally appear too dark Because digital images can be adjusted to many
67. image appears as a thumbnail in the same series as the original image and is displayed in the Image Viewer The new image has the same name as the original with Copy added to the end 5 7 Sending Images from the Image Viewer window You can send images quickly from the Image Viewer window by a number of methods You can send images via email or DICOM You can create a patient CD and you can either create a new case or add images to an existing case The process is much the same as if you did these actions in the Image Explorer window see the following sections in other chapters for instructions To email images from the Image Viewer see 6 5 Emailing Images To send images via DICOM from the Image Viewer see 6 3 Sending Images Via DICOM To create a patient CD from the Image Viewer see Distributing Images in chapter 26 of the Cornerstone User s Manual To create a new case from the Image Viewer see 4 2 Creating Cases To add images to an existing case from the Image Viewer see 4 4 Managing Cases 5 8 Using Imaging Shortcuts The following shortcuts are available in the Image Viewer To use keyboard shortcuts Click the A key to rotate the image 90 degrees counterclockwise Click the S key to rotate the image 90 degrees clockwise Right click while pressing M and moving the pointer This works the same way as the Pan tool and is effective only when the image is larger than the window area
68. image quality the body part that you are imaging must match the exam type that is highlighted The exam type that is selected in the shot tree determines image processing values and the image orientation Use the technique chart that was provided by your installer to select suitable settings for exposure time and kVp on your x ray equipment Position the animal on the table and take the x ray Insert the cassette into the scanner Note If the scanner is unable to identify the cassette size a dialog box appears so that you can specify the size Click Capture A scanning message appears on the screen and the light s on the front of the scanner is are green and blinking IMPORTANT While the x ray cassette is being read do not perform any other operation on your computer e g printing entering data or emailing When the scan is complete the scanner interface closes and the image is displayed in the main window In the shot tree on the right the check box next to the exam type is checked The first image is preserved and the next exam type in the list is automatically selected 126 Chapter 10 Capturing Images 6 The Window Level tool is active so you can adjust window and level contrast and brightness if needed e Click and move the mouse left and right to adjust the window e Click and move the mouse up and down to adjust the level e Click the Presets tool and select Original As initially displayed to restore the
69. in the Type area c Optional In the Default revenue center text box type a revenue ID e g H for Hospital or press F2 to search for and select an ID from the Revenue Center List d In the Pricing area s Amount field type the invoice item price e g 160 00 Tip To specify whether staff with security privileges can change pricing for image shots select the desired Allow change option on the Info tab For example you can select Only increases which allows the price to be increased but never decreased except by a user with administrator security privileges See the Cornerstone Administrator s Manual or the Cornerstone Help system for more information on the Allow change options 242 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration 3 On the Spec Actions tab a Select the Image Request special action b Give the invoice item an Exam Description that specifies the expected number of views and indicates that the shots are not preselected for this item e g 2 Views Select shots 4 lf applicable follow steps 1 3 to set up similar invoice items for 3 views and 4 views depending on how many radiographs you most often take in a set 22 3 2 Advanced example Using service items and smart codes This example demonstrates how flexible and smart you can make your radiography billing methods For IDEXX DR Digital Imaging systems shot trees start off by animal weight so this examp
70. is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software VHS For instructions on using the VHS Vertebral Heart Score tool for measuring cardiac enlargement see 5 2 3 The VHS Tool This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software 45 Chapter 5 Reviewing Images The Zoom menu allows you to zoom in or out of an image by specifying the zoom percentage e Use the drop down list to select one of the preset zoom levels 25 50 75 100 or Fit to Window If you select 100 the image is displayed at the same size as the plate on which the image was captured e Type a number and press ENTER to zoom to that percentage e Ifyou select Actual Size the size of the image on the screen matches the size of the animal that was imaged WARNING The Actual Size tool is only accurate if this image has been calibrated with the Calibration tool If the system and or the image is not yet calibrated when you select Actual Size a dialog box appears so that you can begin the calibration process See the Calibration tool instructions for more details Note Due to dots per inch issues on some computers measurements taken while an image is being viewed in actual size
71. is turned on and that the scanner status indicator shows a steady green light 2 Insert the cassette into the scanner with e The blank side up e The open edge toward the scanner e The cassette centered exactly in the entry slot gt N Note Most cassettes have an arrow in the middle of the open end When inserting a 7 cassette the edges of the cassette should line up between the corresponding indicator marks Figure 18 5 The scanner with a cassette loaded 3 Push the cassette into the scanner until it reaches the locked position The screen is automatically pulled and loaded into the scanner When the screen is loaded the status LED shows blinking green and the buttons on the scanner interface window become active You can now scan erase or eject the screen Note If you do not take any action within two minutes the cassette is automatically ejected and a message is displayed 18 3 2 Removing an Imaging Screen and Cassette from the Scanner After scanning an image the scanner automatically erases the screen so that it is ready for the next use The imaging screen is then ejected into the cassette the cassette unlocks from the scanner and can be removed and reused In the event that the screen and cassette do not eject turn off the scanner and then turn it back on This ejects the screen and cassette If this does not work unlock the cassette manually by pulling the ring beneath the cassette tray 18 3 3 Erasing Imaging Scr
72. networked computer or server it opens in the Figure 5 5 An archived image Image Viewer window b Ifthe archived image is stored in a remote location such as a CD a message box displays that location Insert the disc or browse to the location on the external hard drive or network and click OK The image appears in the Image Viewer window If you want to make this image an active image again a Make a change to the image One easy method is to rotate the image and then rotate the image back to its original position b Click Save d and select Save from the drop down menu You can now use this image as you would any other in Cornerstone Imaging 60 5 10 Viewing Multimedia Files Cornerstone supports the ability to view multimedia files e g ultrasound images You can capture import and view multimedia files multi frame files AVI avi files and MPEG mpg files Note For information on how to import files into Cornerstone see Importing and Acquiring Images from Scanners Ultrasound Digital Cameras etc in chapter 26 of the Cornerstone User s Manual To view multimedia cine files and capture images 1 In the Image Explorer window enter the patient s name and click Search select the patient from the list then click Import Click Open then select File The Select File dialog box appears select the multimedia file that you want to view and click OK The cine file appears in the I
73. not have such structure This is an effect of digital under sampling For small detail objects having a size on the same order of magnitude as an individual pixel or smaller the apparent contrast of that object can vary based on the position relative to the individual detector element locations For example the contrast of a single spherical object the same size as a pixel would have a dramatically different appearance if the object were imaged directly overlying a detector element highest contrast than it would if placed at the intersection of four detector elements lowest contrast Objects inherently smaller than an individual pixel have a radiation intensity signal over an area larger than the small object In each case a lower apparent signal to noise can result in reduced visibility of such objects 216 Chapter 20 The IDEXX I Vision DR system 20 1 Background The IDEXX I Vision DR System uses a direct energy conversion process with a selenium detector plate X rays are directly converted into an electrical signal without a light conversion layer By effectively eliminating the light diffusion present in indirect technology the IDEXX I Vision DR System provides a sharper more detailed image The IDEXX I Vision DR System provides a digital image capture capability for conventional radiographic examinations The system may be used wherever traditional x ray screen film cassettes are used Follow all safety labels on the equipmen
74. not immerse in liquids No field serviceable component inside do not attempt to open the case Control box main power fuse 250V AC 2 Amps Type T To identify any terminal that is intended for connection to an external conductor for protection against electric shock in case of a fault or the terminal of a protective earth ground electrode 224 Chapter 20 The IDEXX I Vision DR System oe Medical equipment with respect to electric shock fire and mechanical hazards only in Se accordance with UL 60601 1 and CAN CSA C22 2 No 601 1 C Medical Device Directive MDD 93 42 EEC applies to all medical equipment except i for active implantable devices 7 Dangerous voltage Alternating current 20 9 4 Signal Input Signal Output Connection Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC standards i e IEC 60950 for data processing equipment and IEC 60601 1 for medical equipment Furthermore all configurations shall comply with the system standard IEC 60601 1 1 Everybody who connects additional equipment to the signal input part or signal output part configures a medical system and is therefore responsible that the system complies with the requirements of IEC 60601 1 1 If in doubt contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 20 9 5 FCC Class A Verification Information to the user This equipme
75. of the pane e Ifthe Thumbnail pane is on the bottom of the window the little black triangles with the red background are on the left side 2 Click the arrows to resize the Thumbnail pane e Click the arrow that points toward the main window to make the Thumbnail pane bigger e Click the arrow that points toward the outside of the window to hide the Thumbnail pane 5 4 Configuring the Toolbar You can customize the Image Viewer by selecting the tools you want displayed in the toolbar at the top of the window Some tools like the Print tool and the Save tool cannot be removed from the To configure the toolbar toolbar 1 Click Display Configuration and select the Toolbar Configuration button from the drop down menu The Toolbar Configuration dialog box appears containing a list of the tools that can appear in the toolbar 2 select the check boxes next to the names of the tools you want to be displayed Uncheck the boxes for tools that you want to hide 3 Click OK when you have finished The toolbar now includes only the tools you have selected 56 5 5 Comparing Images This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software You can select two three or four images in the Image Explorer and compare them side by side in the Image Viewer You can even compare images from more than on
76. option will be selected for you but you will be able to deselect it if you want 102 Chapter 8 Setting Up Basic Imaging Features To add a device to the list of capture sources you can select when you capture an image click the Add Capture Sources button A blank line is added to the list fill in the Description text box for the device you want to add The devices included in the Capture Sources area appear in a drop down list when you add an image allowing you to choose the device used to obtain the image This information is placed in the image record The digital radiography device is preselected as the default When you have finished click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 8 Setting Up Keywords for Images Keywords abdomen femoral etc appear in a list box when you update an image allowing you to select keywords to associate with the image You can then use the keywords to search for images For your convenience a number of keywords have been preloaded into your system You can add delete or edit keywords To add a keyword 1 oo oe e w On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select Keywords Click Add to access the Image Keyword Setup dialog box Enter the keyword description up to 30 characters Repeat this process to add other keywords When you are finished click Sa
77. overall connection status for all the connections that have been set up on this computer Red One or more of the connections is not active Yellow One or more of the connections requires attention Green All of the connections are active To view status for each connection gt Click Connections in the lower left of the Image Explorer or Imaging Dashboard The status bar opens 90 Chapter 7 Other Tools and Tasks Connection status details A colored status icon is displayed for each connection e Red Not running e Yellow Requires attention i e a yellow status for the DICOM connection indicates a problem sending or receiving images e Green Running e Gray Not set up on this computer Note If you move your mouse over an icon text with status details appears The connections are e DICOM This icon appears only on your IDEXX PACS server It shows whether IDEXX DICOM services which sends and receives DICOM images is running It also shows whether any failure has occurred in sending or receiving images You can use the links next to the icon to start or stop DICOM services or to view the DICOM queue Note This icon is activated only if you have DICOM Imaging e Database On a workstation this icon shows the status of the connection to the server e MWL This icon does not apply for the current version of Cornerstone e SmartService This status icon appears only on the Cornerstone server It shows the st
78. result in Adding an exam type loss of data Reshooting an image 2 Use the technique chart that was provided by your installer to select suitable Moving around the shot tree settings on your x ray equipment for exposure time and kVp A Looking at the images you have taken Position the detector plate behind the animal Prep the x ray switch You will see a message that the system is prepping When the system is ready to fire you will hear a beep and see a message that the system is prepped At this point the detector plate is ready 127 Press the switch all the way to capture the image Note To ensure the best image quality take your image within 10 seconds of the system prepped message If more than 10 seconds elapse release the switch and re prep IMPORTANT When taking an image do not perform any other operation on your computer for example printing or entering data You will see a message that the image is being captured This lets you know that the x ray generator has fired The x ray generator makes its standard exposure notification and the Cornerstone system also beeps to let you know that the image has been taken An initial image showing the raw unprocessed data is displayed first then the processed image is displayed In the shot tree on the right the check box next to the exam type is checked The first image is preserved and the next exam type option is automatically selected in the list on
79. select more than one item on the Dashboard lists hold down the CTRL key while you select the items you want In the Image Explorer you can also select a group of images by clicking the first image in the group and then holding down the SHIFT key while you click the last image in the group The first and last images and all the images between them are selected To deselect Items gt If you want to deselect something that you have selected click again while holding down the CTRL key The item or thumbnail is no longer selected To sort columns 1 If you want to change the order in which information is displayed in a table click on the name of the column by which you would like to sort the table Examples of such windows include the Archive Images window and the DICOM Queue 2 Click on the same name again to reverse the sorting order To use drop down calendars e Use the arrow in the upper left corner of the calendar to move back one month into the past e Use the arrow in the upper right to move forward one month e Click the month at the top of the calendar to choose a different month from the drop down list e Click the year and use the arrow that appear to move backward down and forward up through the years 20 Chapter 2 Program Basics To begin image related actions quickly 1 For most of the actions which you can begin on the Image Explorer window such as printing emailing or creating a patient CD if you wa
80. selected will NOT produce any Not Requested image results Cornerstone will count any shots taken during the capture session as part of the request 22 3 1 Basic example Using a Miscellaneous item to bill for a set of images This example shows how to set up a miscellaneous item for a known number of radiographs By designating an imaging invoice item as a miscellaneous item you can give staff the flexibility to free form type a description of the item when invoicing the client With this basic example shots are not preselected when setting up the Image Request special action Instead the expected number of views is indicated in the name of the invoice item and or in the special action s exam description Using a description that identifies the expected number of views helps to communicate the expectation behind the request Remember we are not billing for the number of shots but the set of images as a whole 240 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration Preselecting views at request time vs not selecting views until capture A further level of flexibility is available with this kind of miscellaneous item If you preselect specific views on the Image Request and Results window before the capture session begins e This tells the technician exactly which shots to take e You can better capture missed charges Any shots that are taken beyond those specified will be marked as
81. sign boxes to open a group of exam types See Figures 10 2 and 10 3 To close a group of exam types click the minus sign box 5 When you have found the radiographs you want to take select the white boxes so that a igure 10 5 Cleeastiall beck boxto check mark appears next to the exam types for those radiographs See Figure 10 3 open the next level Click a larger white box to select that exam type 120 Note If you want to add customized exam type collections or new individual exam types to the Choose Exam Type menu contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 6 When you are done click Next at the bottom of the window The Image Capture window appears 7 lo capture the images follow the instructions in this chapter that apply to your digital imaging system 10 5 Capturing the Images The instructions for capturing an image differ slightly depending on which IDEXX Digital Imaging system you are using 10 5 1 Using the IDEXX I Vision DR or IDEXX DR 1417 Digital Imaging System To capture images 1 Inthe shot tree area on the right of the Image Capture window the first exam type in the list is automatically highlighted e lf you want to take this image continue with step 2 e lf you want to take a different image click the exam type for that image to highlight it then continue with step 2 IMPORTANT For best image quality the body part that you
82. specifying exact values select Absolute in the Type text box Enter the window contrast value in the Window text box and the level brightness value in the Level text box To change window and level values relative to their current settings select Relative in the Type text box e Jo increase or decrease values in the Window contrast text box enter percentage values that are greater or less than 100 For instance typing 110 in the Window text box increases the window value by 10 while typing 90 lowers it by 10 Chapter 8 Setting Up Basic Imaging Features 106 8 e To increase or decrease values in the Level Shift brightness text box type the number that you want to be added to or subtracted from the current level value For instance typing 500 will add 500 to the current level value while typing 500 will subtract 500 Click Update The Presets Configuration Detail dialog box closes and the new preset appears in the list of presets on the Presets Configuration information To restore a factory setting preset to its original values several system presets are loaded when the Cornerstone Diagnostic Imaging software is installed If one of these factory setting presets has been edited the Administrator can return the preset to its original settings by doing the following il 2 3 On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select Presets Click the
83. standard exposure notification An initial image showing the raw unprocessed data is displayed In the shot tree on the right the check box next to the exam type is checked and the next exam type option is automatically selected You can take the next radiograph as soon as the light on the black switch box turns green and the software makes a three note beep to signal that image processing is complete TIP The shot tree menu contains other features that allow you to customize your image capture session See 11 3 Dynamic Shot Tree Features for Capture for more information on If you want to capture an image for a different exam type Removing an exam type trom the shot tree click that exam type to highlight it Retaking an image taking additional radiographs for an exam type If you wait the processed image is displayed with a red Adding an exam type crop border Reshooting an image e To accept this crop area right click or simply capture Moving around the shot tree another image Looking at the images you have taken e To reject this crop area left click e To set anew crop area click and drag to draw a new red rectangle and then right click Repeat these steps until you have taken all the images for this patient All captured images are saved to the database when you click Done Capture to complete the capture process 122 10 5 2 Using the IDEXX CR 1417 Digital Imaging System To capture images In the sh
84. status of requests sent to that system Because of this the status for all requests will continue to appear as Requested even after the image has been captured Use the procedure below to manually set the status to Complete so that you can filter the list on the Image Request and Results window and see which requests really are complete To manually set a request to Completed gt On the Imaging Requests and Results window right click the request and select Force Complete Note Only pending requests can be set to Complete This feature is not available for Not Requested you need to deal with those results as described in the section above 290 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration 22 6 Image Request Special Action Item Report Filtered by Modality The Image Request Special Action Item Report groups invoice items by modality The report provides a listing of service type invoice items by modality type that have been set up to initiate the Image Request special action Fields listed on the report include item ID invoice item description amount modality exam description and any preselected shots associated with the item This report is available in the Invoice Item report group sort options for the report include invoice item description invoice item ID and invoice item modality Range options include invoice item description invoice item ID and invoice item modality 206 Secti
85. steps 3 8 until all imaging invoice items that apply to the patient are selected 1When you are finished click OK Each invoice item line is added to the Image Request and Results window as its own separate image request 22 5 3 Selecting Image Shots on the Shot Selection Dialog Box If you have IDEXX SmartLink Digital Imaging the Shot Selection dialog box allows you to easily select the image shots to be associated with each of your imaging invoice items To select image shots on the Shot Selection dialog box 1 2 Double click to open the shot tree for the applicable IDEXX modality Click the plus sign to the left of the desired species or animal category to which the image shot s apply A list of image shots appears Click the check box to the left of the individual shots needed or click the check box to the left of a group anatomical region to choose all shots within that heading When you have selected all desired shots click OK to close the dialog box 250 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration 22 5 4 Managing Image Requests and Results The Image Requests and Results window is a central location where you can see the status of your image requests In Cornerstone 8 2 and 8 3 this window has been enhanced to provide the following new features e Additional filter options for narrowing the list of image requests displayed e A Shot Selection icon that allo
86. the Cornerstone software do the following a Click Attach File The Open dialog box appears b Use the dialog box to select the file s you want to add and click Open c Repeat these steps if you want to attach additional files 3 If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter To remove images or documents from outside Cornerstone 1 On the Case Detail window if the Thumbnails pane is not open click Expand gt gt 2 If you want to remove an attachment or image select its thumbnail and click Remove 3 lf you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter 4 3 3 Adding Images and Other Attachments after Submitting a Case After a case has been submitted you can no longer use Cornerstone to add images or other material to the case Instead you need to use the attachment feature on the telemedicine provider s Web site To add images or other attachments after submitting a case 1 On the Image Explorer click the Advanced Search tab and make sure that the Cases text box is selected 2 Double click a submission thumbnail The submission Case Detail window opens displaying the Case Actions pane and the tab for the telemedicine provider 3 Click View Case A Web browser opens and displays the information on the telemedicine pro
87. the following for disinfection e Dilute bleach solution dilute one part of 5 25 sodium hypochlorite with ten parts of water e A commercially prepared equivalent solution of dilute bleach that does not contain any of the materials listed in the Caution in section 18 3 5 which can cause screen damage Disinfection procedure using dilute bleach solution 1 Wipe with a soft lint free cloth thoroughly dampened but not dripping with dilute bleach Contact the contaminated surface for up to 15 minutes for adequate disinfection 2 Wipe the bleach residue with a soft lint free cloth dampened with water to remove 3 Wipe dry with a soft lint free cloth Allow screens to air dry thoroughly Disinfection procedure using commercially prepared equivalent gt facommercially prepared equivalent solution of dilute bleach is selected it should be used according to its manufacturer s instructions AN CAUTION Be sure all external and internal surfaces are thoroughly dry before elie reassembling and returning screens and cassettes to use the blood and or fluids followed by intermediate level disinfection is indicated prior to use 188 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 5 Scanner Roller Cleaning The roller cleaning process enables you to clean the rollers that feed the screen from the cassette into the scanner Clean the rollers monthly to remove dust and small particles Every 1 000 scanning cycles the so
88. the right e lf you want to capture an image for a different exam type next click that exam type to highlight it e The next image can be taken after 5 to 8 seconds When the system is ready to fire again to take another image the light on the black switch box turns back to green Repeat these steps until you have taken all the images for this horse All captured images are saved to the database when you click Done Capture to complete the capture process 10 6 Reviewing the Images To review the images 1 2 Double click an image name in the shot tree on the right to display that image Use the tools at the top of the window to manipulate the images before closing the capture window Use the following shortcuts to examine and adjust the images e Rotate clockwise Press A e Rotate counterclockwise Press S e Change window brightness Left click and move pointer left right e Change level contrast Left click and move pointer up down e Return to original window level settings double left click Chapter 10 Capturing Images 128 Chapter 10 Capturing Images e Zoom Right click and move pointer up down e Return to original zoom image fits in window Double right click e Move the image Right click while pressing M and moving the pointer only effective when the image is larger than the window area e Magnify an area of the image Press SHIFT and right click while moving the pointer 10 7 Completing the Capture Pr
89. to read the report See the instructions below for further information To add images or other attachments after submitting a case After a case has been submitted you can no longer add images or other material to the case in Cornerstone You need to use the attachment feature on the telemedicine provider s Web site instead 1 Onthe Image Explorer click the Advanced Search tab and make sure that the Cases text box is selected 2 Double click a submission thumbnail The submission Case Detail window opens displaying the Case Actions pane and the tab for the telemedicine provider 3 Click View Case A Web browser opens and displays the information on the telemedicine provider s Web site 4 Use the attachment feature on the telemedicine provider s Web site to attach additional images or supporting material 5 Close the provider s Web site To view and print a report 1 Double click a submission thumbnail with a status of Completed The report opens in the Adobe Reader software formerly Acrobat Reader 2 To print the report click Print 4 8 Viewing Status of Cases Submitted Outside Cornerstone In most cases if you submit a case to your telemedicine provider without using the Cornerstone software the software will be able to match the submission status and any resulting reports to the proper patient in Cornerstone If the status or report does not show up automatically use the following process to manually ma
90. to send via DICOM L Bi Ei to send to telemedicine Cd to email To open the Viewer screen Figure 23 2 The Patient Summary screen K FPA Tap a thumbnail to select it then tap again to open the radiograph on Viewer To open telemedicine status and completed reports Tap a telemedicine status icon to view submission status details or completed report i To display reports on the Dolphin browser save the report PDF then tap E to open To request radiographs bt Tap to request radiographs on Request Screen 262 Chapter 23 Using the IDEXX I Vision Mobile Application 23 4 3 Viewer Safari Browser Top of screen Drag handle down to open the information bar Information bar contains image thumbnails and client patient and image details pes aj hrar lige ia yu Mn Roun THE WD 263 Chapter 23 Using the IDEXX I Vision Mobile Application Bottom of screen Tap a tool in the lower tool bar Tap additional options as needed To annotate an image tap the annotatation tool and then select the drawing option you want Draw on the radiograph with your finger or tap the text option to enter text as shown below 264 FV Walls LOTS oh Identifies viewer features Opens annotation tools Opens zoom controls Opens window level controls vertical changes window brightness horizontal changes level contrast Reverses light and dark Opens flip rotate tools
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92. to their current settings select Relative in the Type text box e To increase or decrease values in the Window contrast text box enter percentage values that are greater or less than 100 For instance typing 110 in the Window text box increases the window value by 10 while typing 90 lowers it by 10 e To increase or decrease values in the Level Shift brightness text box tyoe the number that you want to be added to or subtracted from the current level value For instance typing 500 adds 500 hundred to the current level value while typing 500 subtracts 500 5 Click Save The Presets Configuration Detail dialog box closes and the new preset is added to the list of available presets 5 12 Reverting and Undoing Changes Cornerstone offers you several ways to return your image to an earlier state The Revert to Original tool returns the image to Its original state Any annotations or other changes you made to the image are removed If you want to undo changes made while working in the Image Viewer simply close the Image Viewer without saving When you open the image again in the Image Viewer the image looks the way it did the last time you saved tt If you want to undo changes you made to window and level contrast and brightness since the last time you saved this image click Window Level Presets and then select Original As Initially Displayed from the drop down menu The Reprocess tool is available with certain IDEXX Dig
93. to use or if you have set Figure 4 7 The Case Actions pane showing the Telemedicine tab up more than one telemedicine provider select the Telemedicine tab and then select the provider you want from the Tele Provider drop down list Click Submit A Web browser opens and displays the telemedicine provider s Web site Complete the information needed to submit the case e Although patient data is automatically filled in be sure to check that it is accurate e Select the service for which you want to submit such as cardiology or radiology e Include relevant history and information about the presenting complaint 10 When you complete the submission process close the window for the telemedicine provider s site 37 Note On the Case Detail window in Cornerstone you ll see that the Submit button is now the View Case button Click this button to open a browser window to see the case on the telemedicine provider s Web site To view the status of a telemedicine submission 1 On the Image Explorer window click the Advanced Search tab and make sure that the Cases text box is selected In the Results Detail area a thumbnail is displayed on the left for the Case and thumbnails are displayed on the right for each submission Generally these thumbnails show a service to which the case has been submitted and the status of the submission for that service The thumbnails are updated with the latest status every 5 minutes 2 Double click
94. unchecked exam type starting from the top When you have taken images for all the exam types in the list all the boxes are checked a miscellaneous item appears at the bottom of the shot tree and is highlighted If you take a miscellaneous image Cornerstone applies the settings for the last exam type that you captured Until you take images for them unchecked exam types remain in the shot tree If you decide that you do not want to take an image for an exam type use the To remove a radiograph from the shot tree procedure below Note Adding a miscellaneous image works well if you want to take another image of the same anatomical region as the last radiograph you took However if you want to take an image of a different anatomical region a better method is to add a radiograph using the instructions below When you add a radiograph you select the proper exam type settings for the image and this ensures the best image quality Note If you are using the IDEXX I Vision DR System the IDEXX DR 1417 Digital Imaging System or the IDEXX EquiView Digital Imaging System you can use all of the dynamic shot tree features described in the following procedures If you are using an IDEXX CR 1417 Digital Imaging System including the Model 140 and 140R or the IDEXX I Vision CR Digital Imaging System you can use the procedures to add radiographs and to look at an image you have taken While you are capturing images do the following 1
95. value and safety of your device All necessary servicing including safety inspections for preventive hazard protection is performed at regular intervals IDEXX coordinates service intervals with you depending on the service level you elect Please refer to our extended maintenance agreement terms for a complete description Defective components that influence the device s safety must be replaced by original spare parts Note There are no user serviceable components within the EquiView system All service is subject to the terms of the IDEXX Warranty or Maintenance and Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 206 Chapter 19 The IDEXX EquiView Digital Imaging System 19 6 Repair Defective components that influence the device s safety must be replaced by original spare parts Digital x ray plate 19 7 Accessories 19 7 1 X ray Plate Transport and Storage Case An optional x ray plate transport and storage case with built in temperature control is available if heavy work will be performed by the system in extreme temperatures below 35 F or above 95 F For more information contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Connect the digital x ray plate to a power supply Connector 1 or to the 12 volt electrical system Connector 2 of your vehicle as sh
96. want your search results to include patients who are inactive or deceased check the Include Inactive Deceased Patients check box 5 Click Search to run your search Results are displayed in the Summary List area and the Results Detail area Note If your search criteria will provide a very large number of results and run a long time a dialog box warns you and gives you the option to stop the search 6 If you want to clear the search text boxes and start over click Clear This also clears all the results in the Summary List area and the Results Detail area 2 2 3 The Summary List Area The Summary List area displays the results of your search in a folder tree style list Clients are shown on the first level of the tree furthest to the left Patients are shown in the next level down and dates when images were taken are shown in the next level of the tree In the last level of the tree furthest to the right are tiny thumbnail images representing individual studies and cases gt Click on any level of the list to select a client patient date series or case The Information area displays corresponding client and patient information When you select a patient or date the Results Detail area shows thumbnails of the images for that patient and or date To close and open folders e Click the minus sign to close the folder and hide the items within it e Click the plus sign to open a folder and display the items within it 2
97. 2 4 The Results Detail Area When you select a patient or a date in the Summary List the Results Detail area displays images for that patient or for that patient on that date The images are grouped by study and series The header line for each study displays the study name which is the date and time when the images in the study were captured The header line for each series shows the date that the images in the series were taken and the name of the series 16 Chapter 2 Program Basics To select images e Click an image to select it e Click the area around the images to select an entire series e Click the study header to select the whole study e Hold down the CTRL key while clicking to select more than one image series or study e Hold down the SHIFT key and click two images to select them and everything between them e Click Select All to select all of the images that are displayed in the Results Detail area for this patient Note Image series and study are important concepts in Cornerstone The way images are organized is based on the DICOM Digital Imaging and Communications In Medicine information standard for medical imaging A series holds a group of one or more images and a study holds one or more series When you capture images with an IDEXX Digital Imaging system the images are grouped together in the same study 2 2 5 The Information Area When you select a client patient or date from the Summary List o
98. 20 The IDEXX I Vision DR System e IDEXX is responsible for the safety features of its products only if servicing maintenance and modifications have been carried out by IDEXX or by a person expressly authorized for this purpose by IDEXX e Like all technical devices the IDEXX l Vision DR System needs proper operation regular maintenance and care as described in this supplement e lf you use the system incorrectly or if you neglect to carry out proper maintenance IDEXX cannot be held responsible for resulting errors damage or injuries e Safety circuits may neither be removed nor modified e Safety cannot be ensured if users open the casing of any hardware component of the IDEXX I Vision DR System or remove parts from any component 20 9 2 Applicable Standard The digital x ray plate and associated cables have all been tested for compliance with the safety standards in effect at the time of manufacture in the United States UL 60601 1 Canada C22 2 No 601 1 and the European Union EN60601 1 This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions may cause harmful interference to other devices in the vicinity However there is no guarantee that interference will not occur in a particular installation If this equipment does cause harmful interference to other devices which can be determined by turning the equipment off and on the user is encoura
99. 33 Chapter 11 Image Coach and Other Tools To add a radiograph For all systems 1 Right click an exam type and select Add a Shot from the pop up menu The Add a Shot dialog box appears and displays a menu tree of exam types 2 select an exam type and click Select The new exam type is added to the shot tree and that exam type is highlighted so that you can take the image To remove a radiograph from the shot tree For all systems if you decide that you do not want to take a radiograph for one of the exam types you chose earlier you can remove it from the shot tree 1 Right click the exam type that you want to remove 2 Inthe drop down list select Remove The exam type is removed from the shot tree 3 Select the next exam you want to capture To take an additional radiograph for an exam type retake For IDEXX I Vision DR IDEXX DR 1417 and EquiView systems only 1 After you capture an image select the exam type for that image in the shot tree 2 Right click the highlighted exam type and select Retake Image capture begins and a blue progress bar appears at the top of the computer window You now have an additional image for this exam type represented by an additional line in the shot tree just below the exam type for the original image This new line is labeled with the exam type followed by Retake To take a new radiograph that replaces a radiograph for the same exam type For IDEXX I Vision DR IDEXX DR 1417
100. 4 Setting Up Imaging Integration 22 4 1 Activating Imaging Integration If you purchase IDEXX SmartLink Digital Imaging or Modality Worklist Integration an IDEXX representative activates the feature either on site at your practice or remotely over the phone You can check the following to see if imaging integration is active You can right click in the Patient History area click Imaging and then click Image Request to open the New Image Request dialog box You can click the Image Request and Results button F in the toolbar to open the Image Requests and Results dialog box If you select Controls gt Defaults gt Practice and Workstation from the menu bar and then select Imaging on the left you ll see that the Activate image requests check box is checked To activate SmartLink Digital Imaging or Modality Worklist Integration or if you need to reactivate the feature contact your IDEXX Cornerstone sales representative at 1 800 283 8386 22 4 2 Setting Up Imaging Integration Defaults To set up imaging integration 1 Select Controls gt Defaults gt Practice and Workstation from the menu bar and then select Imaging on the left The configuration options for imaging appear on the right lf the Activate image requests check box is not checked contact your IDEXX Cornerstone sales representative at 1 800 283 8386 to reactivate imaging integration If you want to use special actions with imaging integration select the Use Special
101. 6 2 1 support 1 800 695 2877 Sales 1 800 283 8386 r v7 Bed Be DOO LABORATORIES idexx com cornerstone
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103. Case Categories list select a category that you want to assign to this case If you want to select more than one category hold down the CTRL key while you select the categories you want Note You can select case categories when using the Advanced Search tab on the Image Explorer Window If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter To create a case from the Image Viewer 1 To select the image that you want to use to create a case click the image thumbnail in the thumbnail pane so that a red border is displayed around the thumbnail Note When viewing dental images in template mode you can select images in either the template pane or the overflow pane Chapter 4 Cases and Telemedicine 29 oN ol 10 Chapter 4 Cases and Telemedicine Right click the thumbnail and select Send to from the menu In the Select Action area of the Select Images dialog box select New Case In the Select Image Level area select whether to create a case with just this image with the whole series to which the image belongs or with the entire study to which the image belongs Note For more information about image series and study see 2 3 About Image Series and Study Click Select The Case Detail window appears If the Case Information pane is not open click Expand gt gt In the Case Title text box tyoe a name for th
104. Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window To set Image Viewer display formats for other modalities 1 On the Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Modality Layout 3 To set up how individual series are displayed within a study type the number of rows in the Rows text box and columns in the Columns text box in the Study Layout area 4 lo set up how individual images are displayed within a series type the number of rows in the Rows text box and columns in the Columns text box in the Study Layout area If you want to display the images in a stacked display click Stacked The Template drop down list and the Preview area do not apply 7 Click Save to save and close the System Settings window or click Apply to save without closing the window 113 Section 2 IDEXX Digital Imaging Systems Chapter 9 Imaging systems Overview 9 1 About the Imaging Dashboard The Imaging Dashboard window is designed to give you quick access to common tasks and recently viewed information Note If you are using IDEXX SmartLink Digital Imaging with Cornerstone we recommend that you use the Imaging Dashboard as your starting point when capturing images See Chapter 22 Using IDEXX SmartLink Digital Imaging and Modality Worklist Integration for more information On the left and right sides of the win
105. Ds or DVDs Note on the sending of DICOM files from the Cornerstone software By default the radiograph that Cornerstone uses when it sends a case via DICOM or creates a Patient CD is the original 31 Chapter 4 Cases and Telemedicine version as it looked when you clicked Done Capture at the end of the capture process or when you imported or received the file Changes made on the Image Viewer window such as window level adjustments are not part of the DICOM image that is sent If you want to use the current version of the DICOM image rather than the original version contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 4 5 1 Creating a Patient CD from a Case To create a patient CD from a case 1 Insert a blank CD Note You can also use a DVD if you have a DVD drive and if the computer used to view the images has a DVD drive On the Case Detail window if the Case Actions pane is not open click Expand gt gt Click the Patient CD tab The patient CD options are displayed select CD DVD Do one of the following a Inthe Medical Notes SOAP text box type any notes that you want saved on the CD These notes will be saved in a text file labeled with the name of the case b To add medical notes SOAP from the patient s medical history i Click Medical History li Select the medical notes to include by using the Medical Notes Figure 4 3 The Case Actions pane sho
106. E i i E IDEXX Cornerstone Diagnostic Imaging User s Guide Loman AVAN LABORATORIES Proprietary Rights Notice Information in this document is subject to change without notice Companies names and data used in examples are fictitious unless otherwise noted No part of this document may be reproduced or transmitted in any form or by any means electronic mechanical or otherwise for any purpose without the express written permission of IDEXX Laboratories IDEXX may have patents or pending patent applications trademarks copyrights or other intellectual or industrial property rights covering this document or subject matter in this document The furnishing of this document does not give a license to these property rights except as expressly provided in any written license agreement from IDEXX Laboratories or an affiliate 2012 IDEXX Laboratories Inc All rights reserved 06 28214 03 Cornerstone IDEXX DR IDEXX CR ClearCapture Dx EquiView IDEXX I Vision CR IDEXX I Vision DR IDEXX I Vision Mobile Image Coach IDEXX Patient Clipboard SmartLink and IDEXX SmartService are trademarks or registered trademarks of IDEXX Laboratories Inc or its affiliates in the United States and or other countries DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communication of medical information Microsoft Windows and Vista are trademarks of Mi
107. E EEEE iiaa 197 He EA ed a E E AE E EE E EE T anid don econ EE E E E 198 18 12 Health and Safety Compliance ss sssssssesssssnnriiiinssetttttkkkrtrrrr nett ttEEEEEEEIEEEENEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEE 198 WM E E E A N S S E E ONN A E AA E 198 18 12 2 IEC Standards for Electromagnetic Compatibility and Laser Safety cccccccccccccceeeeeeeees 199 IZ CELONI errer aE ome ene E E E E eee eee ree 199 TT AIE e aym aS U sl S Beene ee Pee ee eee ee A R eee 199 To 2o LA SUING SUT MALAY itty adhd suai hei iit E E RERE AERA AEA AEA AE E i i 200 Pe TC O EEE E EA EA E 200 eee Eese a E E E 201 Te ee 0 GN a EEEE 201 18 13 2 Storage and Operation Environments sancasacncrcnendessdnendtisncntecncecntecrcocetanGnnatenatbainatiendnade Setetatelateta 201 18 14 Caution Regarding Small Detail Object Imaging sssessssssssnnnenrrnrerrnrnrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrens 201 Chapter 19 The IDEXX EquiView Digital Imaging SySteM scccsssesseeeeseeeseeseeeeeeeeees 202 EEES UIC T AEE AE EEE E T E TEE T 202 132 E dupment Dag aisea Aa E a E E ee eee ene AAEE 202 19 3 Cleaning and Maintenance ssssssssesssssssssesttttt ttt tt ttt tt tEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEE EEEE EEEn 204 PLE E AAA E N EE E rer er ee 204 1932 DISIN CIN sere chs eh cae eaa ea aa EOE EN AENA ES SS a a a aN Eaa Eiaa 204 Wo A VUNG O a E A E A E ES 205 T94 MS CONS ccocegoiusaniatata re i E in e AE E E a a aa aa Sa S 205 Me
108. If necessary change the price for the item in the Amount text box Note You may not be allowed to change the item s pricing based on the Allow change setting for this item on the Invoice Item Information window s Info tab If changes are allowed you may be required to select a price change reason 249 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration In the Center text box type the revenue center ID or press F2 to search for and select from the Revenue Center List In the Modality text box select the modality type code for the system used to capture images for this request If this request if for an IDEXX Digital Imaging system do the following a To add image shots for the item click its Shot Selection icon E and specify the image shots to be captured for this item See 22 5 3 Selecting Image Shots on the Shot Selection Dialog Box for more information Note If the invoice item has an Image Request special action associated with it the image shot defaults and exam description defined for the special action will be selected by default b If desired enter capture notes for the item in its Exam Description text box up to 64 characters Note If image shots have not been selected for the item then an Exam Description is required If this request is for a non IDEXX imaging system enter capture notes for the item in its Exam Description text box up to 64 characters Repeat
109. Image Processing To reprocess a radiograph that was captured using ClearCapture Dx Image Processing you need to select a body part and a preset soft medium enhanced or strong The preset applies a different set of image processing parameters to the radiograph The Reprocess area in the lower right of the Image Capture window displays the edge enhancement settings that are currently applied to the image To reprocess an image with ClearCapture Dx image processing 1 Click Reprocess 9 The Reprocess dialog box appears 2 Use the Body Part drop down menu to select large scale processing parameters for a particular body part Most of the time you will not want to change this setting 3 Use the Preset drop down menu to select one of the finer level processing presets for the selected body part 4 Click Apply The image appears with the new edge enhancement applied 12 3 2 Reprocessing with Standard Image Processing To reprocess a radiograph that was captured with standard image processing you change the level and strength values that are applied to the image The level number refers to the size of the structure that is to be enhanced Lower numbers 1 2 will sharpen the edges on fine details such as bone texture Higher numbers 4 5 will sharpen the edges of organs bones and other larger structures The strength number tells the system how much to sharpen A high strength number greater than 50 will sharpen strongly but wi
110. LED No Light Orange Green Blinking Green Orange Green Orange Orange Blinking Orange Green Red Process LED No Light No Light No Light Green Orange Blinking Green Blinking Orange Orange Blinking Orange Blinking Green Red Chapter 16 The IDEXX CR 1417 Digital Imaging System Possible User Action Turn the power on Please wait the reader is powering up Cassette can be inserted Cassette can be inserted Please wait the reader is loading the screen from the cassette Possible actions e Scan the screen e Erase the screen e Eject the screen e Exit the scanner control panel Please wait the reader is scanning ine screen Please wait the reader is erasing the screen Please wait the reader is ejecting the screen Cassette can be inserted Call IDEXX Digital Imaging Support for assistance In the U S or Canada call 1 877 433 9948 165 Chapter 16 The IDEXX CR 1417 Digital Imaging System 16 3 Cleaning and Service The scanner should be kept free of dust and debris Follow these guidelines e Disconnect the reader from the power source and the computer before cleaning e Wipe the exterior case with a cloth and a mild general purpose cleaner e Do not allow liquids to come in contact with any internal components Note There are no user serviceable components within the IDEXX CR 1417 system scanner All service Is subject to the terms of the IDEXX Warranty o
111. Manufacturers Mapping Configuration These windows let you enter a specific device s default location for standard fields e g patient name diagnosis image type as defined in the conformance statement Then you can map that information to your local DICOM server if necessary This ensures that the two devices can exchange information with each other To access these windows select Controls gt Defaults gt Imaging then select DICOM Services and either Manufacturer Configuration or Manufacturers Mapping Configuration from the menu on the left The fifth DICOM configuration selection Auto Routing allows you to set up Cornerstone so that images are automatically sent to remote servers at the end of the capture process Note DICOM services are only configured only on the computer that is the server for your Cornerstone system 8 3 2 Setting Up Local Server Defaults To define the local server configuration for DICOM Services 1 2 On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select DICOM Services and then select Local Server Enter the application entity title for the server in the AE Title application entity title text box This is the name of your local DICOM server Note If you are setting up IDEXX DICOM services on more than one server be sure to give the servers different names since having multiple servers with the same name can create confusion Specify
112. ON Never insert a screen into a cassette unless it is completely dry 186 Chapter 18 The IDEXX I Vision CR Digital Imaging System When the screen is dry position it so that two or three inches hang off the edge of a clean dust free surface such as a tabletop Note Be sure to return the screen to the cassette with the proper side facing up All white screens should have the side marked back side facing the back black side of the cassette For Kodak and CARESTREAM screens the black side of the screen should face the back of the cassette The rotation of the screen i e which edge feeds into the scanner first does not matter Slide the open end of the cassette over the first inch of the screen then slide the screen the rest of the way into the cassette When you reach the end of the screen tip the cassette up so that gravity pulls the screen completely into the cassette eae Release Lever When the screen is completely contained in the cassette pull up on the release lever to Figure 18 10 Removing the extraction tool remove the extraction tool 18 3 5 Cassette Disposal and Recycling CAUTION Kodak and CARESTREAM cassettes contain lead Disposal of lead is regulated due to environmental considerations For disposal or recycling CAUTION information contact your local authorities 18 3 6 Imaging Screen Disposal and Recycling A CAUTION Due to the presence of barium this screen may be considered a haz
113. OU casas Se skataids tadvacdteciceaivedesectchaednuddieeaeeddiwuabessasaumanceesseemeseqeneddosdaniidesteenaa teadsediceadtededeodans 132 TEZA WIE VOC eC UNI CLI Te ROM Oeste ds sre reece hres costes AAEE EENE A EEEE NEES 132 11 2 2 Setting Up the Technique Prompt inincnirtnininencescicsnidesnidtetisbiannteen cece teenceamalpaisathanajatatannidetatatelatalatedad 133 11 3 Dynamic Shot Iree Features for eI S sacs cacecaeatenstass assess ssgssaananssaeatesssa ini kiriieriii rikiriki ihi Ka A iN 133 11 4 The Plate Handle OV NOM carat eave nce se apintn dads laceseapntiesedeipinstosutaaandata cataracts nbetjedslasisaninactadelednindedatniniaeses 135 11 5 Adding a Position Marker to the Image caster pce otnaceeasgsesusanystsesasaeyasst asc eseet cave yae evageys aeten cteeennceteeene re 135 11 6 Using ClearCapture Dx Image Processing Software esssssssseeeeeeeerrrnrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrene 136 UW cl OU DODO I a S AEE 136 11 7 Sending Images Automatically During Image Capture Auto Routing ssseesssseerrrrrrrerrrrrrrerrnnn 136 Chapter 12 Checking and Approving IMageS ssssssunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnna 138 12 Da Cie rai gies 61 Miia 99121 6s eee ener eae ee E EA 138 12 1 1 Is the Image Oriented Properly cccccscccsssccssccsccssccscsceeeeeeeeseeeeseeeeeeeeeseeeeeeeeeeeseseeeeseeesnnnseeness 139 12 2 OCS ihe Image Look RIONU acacrsneisaacceatauancdsessanesenenassscoanwkshahebench
114. R 1417 Digital Imaging System jl Black box with White Box X Ray Footswitch blue and STS Generator green LEDs i o DR Controller Computer Bos n ee i aa Figure 15 1 IDEXX DR 1417 system connection diagram with the black and white boxes ae o Aray Footswitch DR Relay Box generator i Ff X ray detector Computer DR controller box g panel Figure 15 2 IDEXX DR 1417 system connection diagram with the IDEXX DR relay box 153 Chapter 15 The IDEXX DR 1417 Digital Imaging System e Measurement of the safety relevant output parameters e Further special technical inspections for the respective product corresponding to the generally recognized state of the art e Further necessary inspections according to manufacturer s details Note The maintenance and inspections must be carried out only by trained specialists 15 4 2 Operator Inspections The operator needs to check the device for obvious defects see table If functional defects or other deviations from normal operating conditions occur the operator must turn off the equipment and inform IDEXX Digital Imaging Support The equipment can be used again only after repair Operation with defective components can lead to an increased safety risk Interval Scope Method Daily Damaged parts inscriptions warning signs Inspection Daily Damage or breaks in any cables or connection Inspection Daily Water leaks unus
115. Requested Image for dialog box helpful for billing if your Net Hequested a practice bills on a per shot basis Fa my B a aig cart red ETARDA DEA FAEN are aoe he mage 3 If this image is not assigned to the proper patient follow Reassign Patent I NE Magoh Mao image to proper patient and resolve billing below ier EN T 4 Ifyou do not want to bill for this image select Do not bill this client and continue with step 6 5 Ifyou want to bill for this image a Select Bill this client b Select the invoice item ID that you want to use for billing Figure 22 6 The Not Requested Image dialog box c If you need to change the ID click the Invoice item ID field and press F2 The Invoice Item List dialog box appears and displays a list of all the imaging invoice items You have several ways to narrow down this list e lf you want to filter the list by classification click in the Classification text box and press F2 Then select the classification that you use for a particular type of images For example select Radiography to show only radiographs e lf you want to filter the list by Item ID click Item ID in the Search by area and then type the ID in the Item ID text box e lf you want to search by using words that are part of the description click Description in the Search by area and make sure that the Search for word check box is selected Then type part of the description in the Description text box and the
116. Screen To submit the request with or without selecting views tap Submit 23 3 Setting Up the Application on New Tablets To set up the IDEXX I Vision Mobile Application on an iPad device 1 2 oO OY e w Open the Safari browser Type http followed by the IP address for your server and then type the following exactly 8081 i vision mobile Note The IDEXX representative who installed the IDEXX I Vision Mobile Application should have given you the IP address Log in to the mobile application Tap ie and select Add to Desktop Be sure to do this after logging in Close browser Tap IDEXX I Vision Mobile Application desktop icon to start application From now on always use the icon To set up the IDEXX I Vision Mobile Application on an Android tablet You ll need both the default Android browser and the Dolphin Browser application Dolphin for Pad version For the application to work correctly be sure to use the Android browser for steps 1 6 and the Dolphin for Pad browser for steps 7 10 1 2 Open the default Android browser Type http followed by the IP address for your server then type the following exactly 8081 i vision mobile Note The IDEXX representative who installed the IDEXX I Vision Mobile Application should have given you the IP address Log in to the mobile application Tap in the upper right of the Android browser The bookmarks screen opens Be sure to do this after logging in
117. System tab Note To restore all factory presets at once click Restore All and then click Yes in the confirmation pop up Select a factory setting preset and click Edit The Presets Configuration Detail dialog box appears Click Restore All the text boxes are returned to their original values Click Close The Presets Configuration Detail dialog box closes and the new preset appears in the list of presets in the Presets information 8 11 Setting Up Remote Consult and IDEXX Integration Technology for Telemedicine The Remote Consult button connects you to up to five Web addresses for consulting radiology services If you set up IDEXX integration technology for telemedicine you can use the Case feature to send cases to telemedicine providers You can then use the Cornerstone software to see the status of those cases and read the reports that are returned To set up radiologist and or telemedicine addresses for the Remote Consult button 1 2 3 Select Tools gt Settings gt System in the menu bar On the left side of the System Settings window select Remote Consult In the Remote Consult table do the following e Jo add a remote consult address click Add Type a description and a URL address in the row that appears Start the URL with http for best results Chapter 8 Setting Up Basic Imaging Features 107 4 Chapter 8 Setting Up Basic Imaging Features e To update information select the text box that you want
118. To view series side by side on separate monitors Your first monitor always displays the Image Explorer but each additional monitor can be used to display a different series For instance if you have three monitors you can view two series side by side each on its own monitor gt Inthe Image Explorer select the series that you want to view Click the Review button or right click and select Review from the pop up list Each series is displayed in a separate Image Viewer on a separate monitor Thumbnails for all of the images are displayed in a thumbnail window at the bottom of one of the Image Viewers 8 10 Setting Up Window Level Presets Window level presets are available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software You can set up presets to apply new window and level settings to an image in the Image Viewer These presets are available when you click the Window Level Presets tool in the Image Viewer There are two kinds of presets system presets and user presets All users can use the System Presets but only the person who is the Administrator for your Cornerstone software can edit system presets or create new ones Each user can create and edit user presets that are available only to that user 104 Chapter 8 Setting Up Basic Imaging Features To create a new preset 1 On the Controls menu select
119. Up Basic Imaging Features 8 6 1 Setting Up Secure Search Options To help ensure confidentiality Cornerstone allows you to specify when the search function returns results on the Image Explorer and Imaging Dashboard windows You can choose to have the search function return results only when you have typed a full name or only after you have typed a certain number of characters To set up secure search display options 1 Onthe Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Global Settings 3 Inthe Search Matching Options section of the window select one of the following radio buttons e None if you want searches to return a list of results no matter how many characters you type in a search text box e The middle radio button in front of a blank text box and the word Characters if you want to specify a minimum number of characters for searches Type a number in the blank text box Cornerstone will return results only when you type at least that number of characters in a search text box on the Image Explorer window or Imaging Dashboard window for IDEXX Digital Imaging System users e Exact Match if you want searches to return results only when you type the full name Note When the search display is set for either a required number of characters or an exact match you must use the patient name the client first name or client last name text box for every search If you try t
120. Vision CR scanner is classified as a Class 1 laser product A Laser warning During normal operation always keep the scanner enclosed in its protective cover Do not attempt to remove the cover Only a qualified technician may remove the cover to service this product If these substances are detected after the system has been turned on do not attempt to turn off the unit or unplug it Evacuate and ventilate the area before turning off the system Complies with 21 CFR 1040 10 AND 1040 11 except for deviations pursuant to Laser Notice No 50 dated June 24 2007 Class 1 Laser Product and IEC EN 60825 1 Class 1 Equipment Intended for continuous operation Product is provided with ordinary protection against the harmful ingress of water Not suitable for use in the presence of a flammable anesthetics mixture with air or with oxygen or with nitrous oxide 197 Chapter 18 The IDEXX I Vision CR Digital Imaging System The use of accessory equipment not complying with the equivalent safety requirements of this equipment may lead to a reduced level of safety of the resulting system Consideration relating to the choice shall include e Use of the accessory in the patient vicinity e Evidence that the safety certification of the accessory has been performed in accordance with IEC 60601 1 or the system to IEC 60601 1 1 or local equivalent 18 11 Lifting Hazard The Scanner weighs 86 Ib 39 kg Do not try to lift the uni
121. Windows Three windows in the IDEXX Cornerstone Practice Management System can serve as starting points for diagnostic imaging activities Depending on the task you want to accomplish and how you are most comfortable using Cornerstone you may want to use one window or another e The Patient Clipboard window provides information about patients The Patient History area shows all of the image series for the patient In the Patient History you can right click to begin several imaging tasks or to display the Image Explorer window and the Image Viewer window e The Image Explorer window lets you search for clients patients and images and it displays thumbnails of your images organized by client patient date and series Once you have searched for and found images you can begin a large number of imaging tasks by using the buttons on the right side of the window or by right clicking on selected images The window comes in two versions o The Quick Search tab provides the most commonly used search criteria o The Advanced Search tab provides a larger range of search criteria e The Imaging Dashboard is used with IDEXX Digital Imaging systems See 9 1 About the Imaging Dashboard A fourth important imaging window the Image Viewer window displays images so that they can be used for diagnostic purposes and gives you a number of tools to examine and enhance your images The Image Viewer can be accessed from the Patient Clipboard the Imag
122. a submission thumbnail to see general details about the submission on the Case Actions pane of the Case Detail window 3 To view full details of the case click View Case A Web browser opens and displays the information on the telemedicine provider s Web site Submission statuses Started Sending Received In Process Attention Cancelled You have created a case and entered some or all of the information but you have not yet submitted the case to a telemedicine provider Since you may not have chosen a service at this point no service name is displayed on this thumbnail To submit the case expand the Case Actions tab select the tab for the telemedicine provider you want and click Submit You have submitted the case Information and image s are in the process of being sent All images and information for the case have been received by the telemedicine provider The case is ready for a specialist to read it A specialist is reading the case A problem has occurred Click the icon to find information about what has happened and what you should do Situations in which you might see this thumbnail include e Case information was not successfully received e Additional information is needed by the specialist The submission has been cancelled Chapter 4 Cases and Telemedicine 38 Chapter 4 Cases and Telemedicine Completed The specialist has completed reading the case and sent a report back Double click the icon
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125. aging System 10 3 Starting the Capture Process if Capture Software Is Installed Separately If Cornerstone 8 3 software is the first Cornerstone software your practice has installed with an IDEXX Digital Imaging system then the image capturing portion of your software is installed as a separate standalone program on your radiology workstation im ir E lr me Bite Be e i lr EE E mi E E E Et E FU E pL fi a mia E Boe im L F ac Liya Because the capture portion of the software is separate from the rest of Cornerstone you can capture radiographs even if Cornerstone is not available Note In most cases the rest of the Cornerstone software is installed independently on the radiology workstation However some practices choose this configuration the capture portion Figure 10 1 The Capture Setup window of the software installed alone on the radiology workstation and the rest of Cornerstone software installed on other networked computers Important points to remember e Under normal circumstances start all image requests from the Cornerstone software wherever it is located whether on the radiology workstation or on another workstation on the network The Cornerstone software will send image requests automatically to the capture software e Use the capture software for image capture only Use Cornerstone software for all other tasks including o Image viewing and enhancement Cornerstone includ
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127. al e na a Ea e E E AEE 205 19 4 2 Operator INSpeECtOnS c 0 0 0 hebncninindndnimondndnitisndeissdaistdeissdasnsaitntelteDeteceleDeleedsaeehahenanahajagchedecelatetecelatas 205 Derea ee E S EA AE E A E 206 Te A E oe i EE A A EE EEE A accents asi A A AEE E E 207 OFA E E E AA E EE E A T 207 19 7 1 Xray Plate Transport and Storage CASE ccccccccesssessssssessseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 207 E FCC IOO O e E E S E EAER 208 TIS TOON senene e dich ce E E ER a Aa a a E ste dntnthaoee 208 kereg enee SC CAN ONS A E A E AAE 208 We WTC NSC el tate eee he hake oie cede rece te eed NEO EE EEE EKE EEE ei 208 nS Wag ca 2101 E Bc kc Renee eee eee mn een ee oe nay ce nee ee renner Sanaa nett ener se een nen er eee 209 19 03 COmputer o 61210 6rs1l 6 eee eer e tt et ene ene nent nn nee eee rere renee rere eee aria orate iar irra erie ureter rere or eee aera 209 19 9 Environmental C Ondo isses pasaia E E ENTANA EE EEE eee 210 19 10 odioiy Mormane eE E E EEE E EE eer eer ar 211 19 10 1 Safety Statement nnnnsssseeennrinirrrrrrsrrrnnnirtrrrrnse rrtt ttk rrr ranar EEEEEEEEEEEEEESEEEEEEEEEEEEEEEEEESE EEEE rrEn 211 1910 2 Applicable standa h erescecedansmeen inier r EO EE EEEE 212 O Wy OO E E nie ceeeeeeeccaseapiiare 213 19 104 FCC Class A VCC AOU suis sinc sian nandi ara Eaa aN Ea A DAA AAA AAAA AAAA a aini 214 19 10 5 General Safety Information s cninindninarismanisnindtienseasictendnssisusmcaentndecattotndacaitinbamabayanan
128. al integration For high level integration How does the The system does not automatically The system auto routes images to The system supports the DICOM Modality system use send images to Cornerstone You Cornerstone using DICOM Performed Procedure Step MPPS feature DICOM may be able to use DICOM to The system can support MPPS on its own or import images manually with the help of additional software Can you send image requests from Cornerstone to the system Does Cornerstone capture charges automatically for requested images Does Cornerstone prompt you about billing for not requested images How is the image The image is not displayed in Cornerstone stores a copy of The imaging system stores the image displayed and the patient history or stored in the image and attaches It to the and attaches it to the medical record stored Cornerstone unless you import it medical record automatically When opened for viewing manually the image is displayed in the Cornerstone Image Viewer Can you see the Because the system isn t fully integrated Cornerstone is not able Completed requests are automatically request status in to display whether or not the image request has been completed marked as completed Cornerstone This means you ll need to manually mark requests as completed in Cornerstone after you capture the images on the system 237 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist I
129. apply to your IDEXX Digital Imaging System After the images are captured they are automatically sent to the Cornerstone software and are added to the patient record To capture images when Cornerstone is not available The following steps apply if Cornerstone is not available either on the radiology workstation or on the network for example Cornerstone is being upgraded or Cornerstone resides only on the network but the network is down 1 Start the capture software on your radiology workstation 2 Click Capture Images 3 Search for and select the patient or add a new patient if needed The capture setup window is displayed 4 lf your user name does not appear in the Technician text box at the top of the window select it from the drop down list 5 Inthe Veterinarian text box select the name of the veterinarian for whom you are capturing the images 119 Chapter 10 Capturing Images 6 Click Next and then follow the instructions later in this chapter that apply to your IDEXX Digital Imaging System IMPORTANT Captured images will be sent to Cornerstone software as soon as the software is available again The images will be labeled as Not Requested If this is a new patient a new patient record will be created automatically in Cornerstone as well Add the Not Requested images to the patient invoice and bill appropriately For instructions see 22 5 7 Charging for Not Requested Images 10 4 Starting the Capture
130. ardous or special waste at the end of its useful service life For disposal or recycling information caution contact your local authorities 18 4 Scanner Cleaning and Service The scanner should be kept free of dust and debris Follow these guidelines Disconnect the scanner from the power source and the computer before cleaning Wipe the exterior case with a cloth and a mild general purpose cleaner Do not allow liquids to come in contact with any internal components A small vacuum cleaner may be used with care to remove hair and dust from the cassette tray CAUTION Do not use alcohol or alcohol based products to clean any scanner components Note There are no user serviceable components within the IDEXX I Vision CR system scanner 187 Chapter 18 The IDEXX I Vision CR Digital Imaging System All service is subject to the terms of the IDEXX Warranty or Maintenance and IDEXX Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 18 4 1 Scanner Cleaning and Service AN CAUTION If the equipment is visibly contaminated with blood or bodily fluids removal of CAUTION CAUTION Dilute bleach solution may cause eye irritation and dry skin Wash hands with A N soap and water following use Consult the manufacturer s Material Safety Data Sheet caution MSDS for additional information prior to use Disinfection materials Use one of
131. are When you click the Edit Series Layout tool a grid of boxes appears By dragging across and down this grid you can select how many rows and columns of images will be displayed within each series in the Image Viewer The largest arrangement you can choose is four images wide by four images tall Note These layout changes are not saved when you close the Image Viewer Use the Edit Modality Defaults tool if you want to make layout changes that will be applied every time you use the Image Viewer The Edit Study Layout tool allows you to specify the way that the series within a study are displayed This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software When you click the Edit Study Layout tool a grid of boxes appears By dragging across and down this grid you can select how many rows and columns of series will be displayed within each study in the Image Viewer The largest arrangement you can choose is four images wide by four images tall Note These layout changes are not saved when you close the Image Viewer 49 g Chapter 5 Reviewing Images a See 5 4 Configuring the Toolbar for information on how to use this tool to customize the buttons that appear in the Image Viewer toolbar ab The Toggle Annotations tool allows you to show or hide image annotations The Toggle Overlays to
132. artLink Digital Imaging only To add or edit image shots for an invoice item in the image requests grid click the item s Shot Selection icon and specify the image shots to be captured for this item See 22 5 3 Selecting Image Shots on the Shot Selection Dialog Box for more information on selecting image shots E ee oe oe ote oe 6 64 a amp Be OB P Shot Selection Le Of iiri head L ft All Beare late Bias SMEG Madi Animal 20 ta agp a ee EATE The i Pee eh Thi ke Frank Eales ed Froni Bete Ah Dangle Rear Eaiarmntigs Rear Experian Ath Drplaent Palvin Palade With implart T L Payal hielo H AID E L t F AMD Laft Lat a RANG YO AWD oY Metal Sarai giii THL Bulla ar FT Tiii FENHHEN GFA Pore eo gern bnie ap Famaetony Lipan geara Dyrby um Figure 22 3 The Shot Selection dialog box ee k LE f EL Hakaa h See F a Li Figure 22 4 The New Image Request dialog box when starting with a special action 248 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration Note The Shot Selection icon displays as a shot tree with a sign ig if shots have not been added for the item and as a standard shot tree no sign if shots have already been selected for this invoice item If necessary enter or edit request notes for an imaging invoice item in its Exam Description text box up to 64 characters Note If image
133. ase the mouse button Right click on the bar at the top of the thumbnail pane and select e Move left to move the Thumbnail pane to the left side of the window e Move right to move the Thumbnail pane to the right side of the window e Move down to move the Thumbnail pane to the bottom of the window To hide the Thumbnail pane gt Click on the line between the Thumbnail pane and the main Image Viewer window so that the pointer becomes a two sided arrow Hold down the left mouse button while you drag the line to the outside edge of the window gt Right click on the bar at the top of the Thumbnail pane and select Hide Chapter 5 Reviewing Images 09 Chapter 5 Reviewing Images To resize the Thumbnail pane gt Move the mouse over the thin line between the main window and the Thumbnail pane so that the pointer becomes a two way arrow Click and drag to make the pane larger or smaller gt Right click on the bar at the top of the Thumbnail pane and select e Hide to shrink the Thumbnail pane to a thin line on the edge of the Image Viewer e Maximize to make the Thumbnail pane as large as possible e Restore to return the Thumbnail pane to the last size that you made it undoing the most recent size change To resize or hide the Thumbnail pane using the pointer arrows 1 Find the pointer arrows e Ifthe Thumbnail pane is on the right or left side of the window there are two little black triangles on a red background at the top
134. at you erase any imaging screens that have not been used in several days see 17 4 4 Erasing Imaging Screens for more information 172 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System 17 4 2 Loading a Cassette To load a cassette into the scanner L 1 Be sure that the scanner is turned on and that the scanner status is Insert Cassette Both L status LEDs are green and neither is blinking 2 Insert the cassette into the scanner with e The blank side up e The open edge toward the scanner e The cassette centered exactly in the entry slot Note Most cassettes have an arrow in the middle of the open end When inserting a cassette always line up this arrow between the two green LEDs on the scanner 3 Push the cassette into the scanner until it reaches the locked position The scanner status Figure 17 6 The scanner with a cassette loaded indicates Loading Cassette Screen both LEDs blinking green The screen is automatically pulled and loaded into the scanner When the screen is loaded the status changes to Ready for Scan both LEDs steady green You can now scan erase or eject the screen Note If you do not take any action within two minutes the cassette is automatically ejected and a message is displayed 17 4 3 Removing an Imaging Screen and Cassette from the Scanner After scanning an image the scanner automatically erases the screen so that it is ready for the next use The i
135. atients and studies you have viewed You can specify how many days of each you want displayed To set up dashboard lists 1 On the Controls menu select Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select Dashboard The Dashboard Configuration window appears In the Days of Clients to Display text box type the number of days In the Days of Patients to Display text box type the number of days In the Days of Studies to Display text box type the number of days w a S w Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 14 2 Setting Up Auto Routing The auto routing feature allows you to automatically send images via DICOM to a destination of your choice You have a choice of auto routing settings e Automatic completely automates the sending of images At the end of the capture process images are sent to a designated address e Semi Automatic lets you select from a list the images you to want send and the destinations where you want to send them e Manual deactivates automatic sending This option is for users who prefer to send images manually For more information about sending images manually via DICOM see 6 3 Sending Images Via DICOM 147 Chapter 14 Setting Up IDEXX Digital Imaging System Features The DICOM queue allows you to check the progress of images as they are being sent and lets you pause restart or canc
136. atus of your connection to IDEXX SmartService technology which allows you to upgrade your software over the Internet e Telemedicine lf you have set up a connection to one or more telemedicine providers this icon shows the status of those connections e SmartLink lf IDEXX SmartLink technology is set up for your IDEXX Digital Imaging system this icon shows the status of the connection between the imaging software and the rest of the Cornerstone software Note Other connection indicators may be displayed but only the connections listed above are meaningful with Cornerstone 91 Chapter 8 setting Uo Basic Imaging Features This chapter covers the process of setting up basic imaging features supported by both DICOM Imaging and IDEXX PACS software These features are also part of the Diagnostic Imaging module available with Cornerstone 8 2 and earlier sections 8 1 through 8 13 cover the defaults available on the Imaging Configuration dialog box while sections 8 14 and following cover defaults found elsewhere in Cornerstone 8 1 Setting Up Image Archiving Defaults Archiving refers to moving images from your computer to another storage location Archiving is usually not necessary however if you do choose to archive images you can have the software alert you whenever it is time to archive For information on how to archive images see Archiving Images in chapter 26 of the Cornerstone User s Manual Note You will al
137. back views of the IDEXX CR 1417 system scanner and positions of the following components Pauera reanvew dische Power Connector USB Connector Scanner status LEDs Indicate the status of the scanner Cassette tray lnserts the cassette into the scanner for scanning and erasing the imaging screens Power switch Turns the scanner on off Power connector lIs where the AC power cable plugs into the scanner USB connector Connects the scanner to the computer via a USB cable Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System 17 2 1 Safety Information For your protection and for the protection of the equipment use the IDEXX CR 1417 system scanner only in the manner outlined in this supplement and in the manufacturer s hardware guide which Se eee you received with the scanner For detailed safety and regulatory information including certification ce GE information please see the hardware guide z a w CLASS T LASER PRODUCT The Certification and Identification Label shown in figure 17 3 is permanently affixed to the rear cee panel of the IDEXX CR 1417 system scanner DEVIATIONS PURSUANT TO LASER NOTICE Wa 50 DATED CERTIFIED OMIY TO CANADIAN ELECTRICAL CODE GERTIE EN VERT DU CODE CANADIEN l DE CELECTRICITE SEULEMENT CAUTION Do not use the scanner within six feet of a patient ripiena oa AX Fiona SOE krati CAUTION tne rai FA Perey Figure 17 3 The IDEXX CR 1417 Model 140 or 140R syste
138. box where you can view and update additional details about the image including Title Technique information and Comments You can also mark this image as a key image by checking the Key Image text box See 5 13 Editing Image Details for more information Rotate and Flip Tools Click the Rotate and Flip tool to open the Rotate and Flip toolbar These tools allow you to change the orientation of an image Note If you rotate or flip an image that has annotations on it the annotations will rotate or flip as well Note After an image is rotated a marker appears and shows the number of degrees clockwise the image has been rotated from the orientation in which it was captured An XI marker appears after horizontal flios and a Y after vertical flios These markers are always displayed with the image in Cornerstone and cannot be hidden The Rotate Clockwise tool rotates an image 90 degrees clockwise each time the tool is clicked The Rotate Counterclockwise tool rotates an image 90 degrees counterclockwise each time the tool is clicked The Flip Horizontal tool flios an image along the Y axis each time the tool is clicked The Flip Vertical tool flips an image along the X axis each time the tool is clicked 42 Chapter 5 Reviewing Images The Window Level tool allows you to manipulate the contrast also called window and brightness also called level Click the Window Level tool and then click and drag th
139. ceable parts inside WARNING ELECTRIC SHOCK Line voltage for the IDEXX CR 1417 system scanner is 100 240 VAC 50 60 Hz To prevent electrical shock be sure to plug the equipment into a properly grounded electrical outlet Grounding can be ensured when the equipment is connected to receptacle marked HOSPITAL ONLY or HOSPITAL GRADE only Do not operate the reader around water or near a wash basin WARNING LIFTING HAZARD The IDEXX CR 1417 system scanner weighs 88 Ib 40 kg Do not try to lift the scanner by yourself Always seek assistance from another person Lifting equipment that is too heavy may result in serious injury to personnel and or damage to equipment 167 Chapter 16 The IDEXX CR 1417 Digital Imaging System All service is subject to the terms of the IDEXX Warranty or Maintenance and Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 WARNING To ensure that the IDEXX CR 1417 system scanner operates properly never use the equipment in temperatures below 64 F 18 C or above 86 F 80 C Never operate the equipment in humidity levels above 80 16 7 Before Reading an Imaging Plate Check to ensure that e The USB cable is connected between the computer and the scanner e The scanner is plugged into the power source e The scanner power switch is turned on e The computer and monitor power switches are t
140. ceccccecscecececeeseeeeceeceseeseeseseeeeeeeseeeseseneees 174 TG AI an image COO eneee suenannacsssseeecsueesuaantsapceapaceeceapaseensta cy to snaadainaicumintnaatanntnoancnte 174 17 5 Scanner Cleaning and Service oicrcincdscninsancntndnsncuitoateseatasicaasiwatstdatndaltaaltadadadaliadataehslbehabsaebehebihesndndiimiiindinnsiaiiian 176 WG CAINS Roler EANN serere nEs R R NANA AE ERREEN 177 17 7 Caution Regarding Small Detail Object IMAGING sssssssssssssssssssssnnnnnnnnritktkkttttriitrrtrtrrtrrrrrrrrrrrrrrrrrrrr 179 Chapter 18 The IDEXX I Vision CR Digital Imaging SySteM ccssecssssseseseeeeeeneeeeeseeeees 180 EE Ee a a PEA L E E A A E NEN A E E E E E EA eee 180 18 2 The IDEXX l Vision CR Scanner fsstccccestecnatesndedidawadavadswedaeadanxnsdwavdvenduavdassaisisduhataububwksbenentaesbeeneinenenulad 181 18 2 1 Before Using the Scanner os Secsensnsentosnanuntteeteaveecenetetecuntabadcnabeendceannchlecadesadasadesadslndwdcndecutoceaudll 182 18 2 2 Scanner Status INGICALON ccccccsssssssssccccceccesccesceeeeeseeeeeseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeseesseseeesenesnnnnneess 182 18 3 IDEXX l Vision CR Imaging Cassettes and Screens ssssssssseererreerrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrena 182 18 3 1 Loading a Cassette iiisiriiiiiisiiiciinnneedenedeeddede heessa iniaiaiai raadadidadidadidadiaadin 183 18 3 2 Removing an Imaging Screen and Cassette from the Scanner ccccccccccccccssseceeeeeeseeeeeeeeees 183 1
141. cei cis indnlntnindelnceladesesmssendasnissnddglecevatecntecatecatdlvisdsisisiedoisidiadalatataielads 219 CAGES i E E ETE A A E A E EET 220 206 DEDO d reie a aa EE SE EE ee ee eee ree ae 221 noen ee Eea a e E A NE AR E EET 221 20 8 Environmental GOMGIIONG v2 55 siaachetenchanstadaindntaiuinde nir teren rini Eni Ene EC KEETE C EEEE TECC na ia akian i naaa 221 ao e A Oo a EE E A 222 20 9 1 Salety Statement osryaias rar anin tidied s Ene ENERE ute ante te EEEE aaa aa aa aai hia n 222 A P a a T e AES S E eee ee r rS 223 AE EEE E E E 224 20 9 4 Signal Input emia Output CPIM CTO lal recsrerisn Mau tare ve venaremre rama cenaes 225 20 953 FEC GASS Fy VENMOCAUONY ecececnce icc tier sntsontaeetasnebane iE S EEEE REEE 225 20 9 6 General Safety NOMAN N ressanar r erene r erare TATO ANONN ANa NaNO EEEE E aai 226 20 9 7 Sealed System Safety and Cleaning Information sssssssssssssssssssssrsnnrrnrrrirrrrrrrrrrrrrrrrrrrrrrrrrrrrn 226 20 9 8 Electrical Safety Information sessssssssssssssssssssersnrrsrsrrrrrrrrrttrrtttttttttttttttttrrtrrrtrrrrrrrrrrrrrrrrrrnna 227 20 9 9 Power Cord Safety Information cecset cove centncetncatarcednvnsdentenestnnddnndaesueestlnendinewnentladeeerbeauhaetencheieianabes 227 20 9 10 Mechanical allel y IINOnnmialOM accccccerncescrereranarasercdecsuscececsusgecdeateaa aaa uaacaaeeawaeeauecaneeeeeeeeieeenees 228 20 10 Caution Regarding Small Detail Object IMAGING sssssssssssssssssssssssssssnnnnnrrrrrrrrrirrtrirrrrrr
142. ch the selected images belong e Select Study to create a case with the study to which the selected images belong e Select Apply Overlays if you want the images to contain the overlay information displayed in the Image Viewer e Select Apply Annotations if you want the images to contain the annotations created in the Image Viewer Note For more information about image series and study see 2 3 About Image Series and Study For more information about applying overlays and annotations see 6 6 Applying Annotations and Overlays Click Select The Email dialog box appears In the To text box select or type the email address or leave the default value Note You can also click Address Book select an email address and click OK to load that email address in the To text box See 6 5 1 Using the Address Book In the Subject text box type the subject of the email or leave the default value your practice name To include a message type it in the Message text box select the image file format in the Export File Type drop down list The text boxes in the lower left corner of the dialog box display the number of images and the estimated total size of the images in megabytes MB Click Send to complete the process To email images series or studies from the Image Viewer 1 To select the image that you want to send click the image thumbnail in the Thumbnail pane so that red borders are displayed around the thu
143. comdrop directory 95 Chapter 8 Setting Up Basic Imaging Features 14 In the Watch Interval in seconds text box specify how frequently DICOM Services should check the watch directory Set the value to O if you do not want DICOM Services to check the watch directory 15 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 3 3 Defining Remote Server Configurations To add a new remote external server 1 2 On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select DICOM Services and then select Remote Servers Click the Add New Server button to add a new row to the Remote Servers table In the Server Name text box enter the name of the external server The name you enter appears in the Configure Servers drop down list when you finish entering this server s data Enter the external server s IP address in the Server Address text box Enter the port number for the external server in the Port text box Enter the name of the called application entity in the AE Title text box This is the application entity title for the external server you are configuring In the Support Query Retrieve text box select the check box if you want to be able to use the DICOM Query Retrieve feature to search for the images and then import them from this remote server For more information see 3 2 Using DICOM Query and Re
144. crosoft Corporation registered in the United States and other countries iPad and safari are trademarks of Apple Inc registered in the United States and other countries Android is a trademark of Google Inc Java is a trademark of Sun Microsystems Inc Kodak is a trademark of Eastman Kodak Company registered in the United States and other countries CARESTREAM is a trademark of Carestream Health Inc Dolphin Browser is a trademark or registered trademark of MoboTap Inc GestureWorks is a registered trademark of Ideum Inc All other product and company names and logos are trademarks or registered trademarks of their respective holders Illustrations provided by GestureWorks www gestureworks com The IDEXX Digital Imaging Systems are intended for veterinary use only they are not intended for human diagnostic use r sir Bed Bae POO LABORATORIES Contents Chapter 1 VERO CUO ovens seteesics scene tesnesiresssuwsecteosvcessuwerisewastedetenocts veoeuoumunsimnsnusvcseestiasnanuerenes 10 et Pe NS agate E A E E 10 1 2 Overview of Imaging IN Cornerstone cccccccceeceeeeeeeeeeeeeeeseeeeseeeseeeeeeeeeseneereteseeeeseeeeseseeeeeeeseeeseeeeeeees 10 Section 1 Diagnostic uits 0 ieee kene eee Eee ee eee eee eee eee 13 Chapter 2 Program BasSiCS nasnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn nnmnnn 13 A1 Key DiagNosico Imaging WiINdOW S cacsonspaect asapseasalassnasancustatarencs lt saota
145. d tighten the screws for each Turn the DR Controller Box on Do the following to test the installation If you don t see the correct response from the system at any point in this process call IDEXX Customer support at 1 877 433 9948 a On the front of the DR Relay Box use the tip of a pen or pencil to press the switch to the left of the Test LED The LED should turn green b While still pressing the Test switch press the foot or hand switch as you usually do to prep the system The Test LED should blink now but still be green 233 Chapter 21 The IDEXX DR Relay Box c While continuing to press the Test switch press the foot or hand switch as you usually do to expose The yellow X Ray Exposure LED should be on during exposure d Release the Test switch and foot or hand switch e Turn on the computer and the generator f Take a sample DR radiograph to verify that the system is working 234 Section 3 Imaging Integration Chapter 22 Using IDEXX SmartLink Digital Imaging and Modality Worklist Integration 22 1 Overview Through imaging integration Cornerstone communicates with a variety of imaging systems This communication allows you to send requests to a system Depending on the capabilities of the system Cornerstone may be able to track the completion of the request and the image may be stored in or accessible from the medical record 22 1 1 IDEXX SmartLink Digital Imaging IDEXX SmartLink Digital Imaging all
146. d transmitters such as base station for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the scanner is used exceeds the applicable RF compliance level above 195 Chapter 18 The IDEXX I Vision CR Digital Imaging System the scanner should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the scanner b Over the frequency range 150 kHZ to 80 MHZ field strengths should be less than 3 v m Recommended separation distance between portable and mobile RF communications equipment and the scanner The scanner is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the scanner can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communication equipment transmitters and the scanner as recommended below according to the maximum output of the communications equipment W rated maximum output power of m separation distance according to frequency of transmitter transmitter 150kHz to 80 MHz 80 MHz to 800 MHz 800 M Hz to 2 5 GH
147. dialog box appears 2 Verify image request details i e staff amount etc and make changes if necessary 241 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration Modify or add to the exam description to tell the technician which shots are needed For instance if you want LAT and VD shots to be taken you might make the description R LAT VD Abdomen The exam description also helps identify the request on the Image Request and Results window Click OK on the New Image Request dialog box The charge is automatically recorded on the INVOICE On the PVL change the imaging item description so that it s more descriptive for the client e g 2 Views Abdomen When ready to begin the image capture process select this request on the Image Requests and Results window and click Capture Images Note The information given in the item description and exam description text boxes may help you know which views are needed and help you begin setting up The Capture Setup window appears The exam description is shown in the Request Notes text box select the shots in the Choose Exam Type area and click Next to continue the capture process How to set it up iv a Create a service type invoice item On the Info tab a In the Item information area give the invoice item a name that indicates the expected number of views e g Radiographs 2 views b Select Miscellaneous item
148. dow are lists of the most recent clients most recent patients and most recent image studies that you created or updated Clients and patients are listed alphabetically the studies are organized with the newest studies at the top of the list You can refresh the Dashboard with the latest information by clicking Refresh in the upper left of the window In the middle of the window are the Capture Images and the View Images buttons To capture or view images you can use the Dashboard buttons alone or in combination with a selection in one of the most recent lists Note You can display the Imaging Dashboard at any time by clicking the Dashboard button LJ in the toolbar at the top of the window or by selecting Activities gt Imaging gt Imaging Dashboard from the menu To capture images Do one of the following Figure 9 1 The Imaging Dashboard window e Click Capture Images without selecting anything in any of the lists The Select Client and Patient dialog box appears so that you can select a patient and begin the capture process 114 select a client in the Recent Clients list and then click Capture Images The Select Client and Patient dialog box appears with the client information already filled in so that you can select one of this client s existing patients or add a new patient to begin the image capture process Select a patient from the Recent Patients list then click Capture Images The Select Client and Patient dia
149. e The table on the following page offers a more detailed view of the features available in each level of imaging ii Chapter 1 Introduction Cornerstone DICOM IDEXX PACS IDEXX PACS Software DICOM Imaging with Imaging Imaging Software with IDEXX SmartLink Modality Worklist Technology Integration Image Explorer Image Viewer Create patient CD Send image via email Add basic annotations Import basic image types JPEG BMP TIFF Scan images Import images Telemedicine DICOM Send receive import query retrieve and auto route Use advanced annotations and tools Capture stills from videos Multiple image layout by modality Apply preset window level adjustments Capture radiographs Create image request Automatically capture charges for requested images View request status Prompt to bill for nonrequested images View completed image Save image to medical record g m 2 lt gt lt se ep O b D se Cp O 2 je mD D Q gt D OQ O O J D eA O D O O NO z C O Q D O sab O Z 3 sab 09 C D D D O gt op D W op 3 a lt D O 09 C O O D Q O lt v D O D m gt lt gt X lt 3 Q 9 O sab el z Q lt O 09 Section 1 Diagnostic Imaging Chapter 2 Program Basics 2 1 Key Diagnostic Imaging
150. e IEC 61000 4 5 2 kV line to earth 2 kV line to earth Voltage dips lt 5 UT gt 95 dip in lt 5 UT gt 95 dip in short interruptions Ur for 0 5 cycle UT for 0 5 cycle and voltage 40 Ut 60 dipin 40 Ur 60 dip in Ur variations on Ut for 5 cycles for 5 cycles power supply ines 70 UT 30 dip in 70 UT 30 dip in UT Ut for 25 cycles for 25 cycles IEC 61000 4 11 O o lt 5 UT gt 95 dipin lt 5 UT gt 95 dip in UT for 5 sec UT for 5 sec Power frequency 3 A m 3 A m 50 60 Hz magnetic field IEC 61000 4 8 Electromagnetic environment guidance Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment If the user of the scanner requires continued operation during power mains interruptions it is recommended that the scanner be powered from an uninterruptible power supply Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment Note UTis the AC Mains voltage prior to the application of the test level 194 Chapter 18 The IDEXX I Vision CR Digital Imaging System Guidance and man
151. e Cursor e To the right to increase the window e To the left to decrease the window e Up to decrease the level e Down to increase the level Note For a detailed explanation of window and level see 5 11 1 About Window and Level Contrast and Brightness Annotation Tools Click the Annotate tool to open the Annotation toolbar You can use these tools to draw on an image or to make annotations on an image iy Pointer Use this tool to manipulate an annotation that you have already placed e To move an annotation click the Pointer tool select the annotation and move it to the new location e To delete an annotation click the Pointer tool right click the annotation and select DELETE e To change the font color or size of a text annotation click to select the annotation and then right click on the annotation with the Pointer tool Make the desired changes and click OK e To change the units of measurement line attributes font or color right click on the annotation with the Pointer tool Then make the desired changes and click OK Arrow Click and drag to draw a straight lined arrow 43 Chapter 5 Reviewing Images ce Calibrate Click and drag to draw a line on the image that corresponds to a feature on the image for which you know the actual measurement The Calibration settings dialog box appears Do the following 1 Click OK in the Message dialog box and then draw a line on the part of the image f
152. e information in the table is every few seconds To see the most current information click Refresh e To change the status of images in the queue use the buttons on the right side of the DICOM Queue window o Select a Received or Failed image and click Remove to remove that image from the table o Select Clear Completed to remove all the Received images from the list 78 Chapter 6 Distributing Images and Using DICOM e When you have finished using the DICOM queue click the X in the upper right corner of the DICOM Queue window The window closes 6 4 3 Viewing status of the DICOM connection To view the status of the DICOM connection A status icon appears in the lower left of the DICOM Queue window The icon tells you about the status of the DICOM connection through color and text e Green DICOM started IDEXX DICOM services are running and the queue does not contain any sent or received images with a status of Failed e Yellow check the queue for information about sent or received images that have failed You may see this status when DICOM is started or when it s stopped e Red DICOM stopped the DICOM server is not running If you are on the computer that is your IDEXX PACS software server click Restart DICOM Services 6 5 Emailing Images You can email images quickly from either the Image Explorer or the Image Viewer You can email an image series or study Also you can select the format in which the images
153. e such as a tabletop Note Be sure to return the screen to the cassette with the proper side facing up All white screens should have the side marked back side facing the back black side of the cassette For Kodak and CARESTREAM screens the black side of the screen should face the back of the cassette The rotation of the screen i e which edge feeds into the scanner first does not matter Slide the open end of the cassette over the first inch of the screen then slide the screen the rest of the way into the cassette When you reach the end of the screen tip the cassette up so that gravity pulls the screen completely into the cassette ae es a When the screen is completely contained in the cassette pull up on the release lever to remove the extraction tool Figure 17 10 Removing the extraction tool 17 5 Scanner Cleaning and Service The scanner should be kept free of dust and debris Follow these guidelines Disconnect the scanner from the power source and the computer before cleaning Wipe the exterior case with a cloth and a mild general purpose cleaner Do not allow liquids to come in contact with any internal components A small vacuum cleaner may be used with care to remove hair and dust from the cassette tray CAUTION Do not use alcohol or alcohol based products to clean any scanner components Note There are no user serviceable components within the IDEXX CR 1417 system scanner All service is subject to
154. e the DICOM drop folder feature can help you do this more easily When DICOM images are copied to a specified directory Cornerstone automatically detects them and imports them These images are then available and can be viewed and enhanced like any other images Note For information about setting up this feature see steps 14 through 17 in 8 3 2 Setting Up Local Server Defaults We recommend that you test the DICOM drop feature with a single image to ensure that all settings are properly configured To import images from the DICOM drop folder 1 Inthe Microsoft Windows operating system copy DICOM images to the DICOM drop folder By default this folder is C Cstone dicomdrop If you are importing a large number of images the process may take a couple of minutes 2 When the import process is complete you can use the Patient Clipboard or Image Explorer to search for and review the images 23 Chapter 4 Cases and lelemecdicine Cases can be used to send images to a independent radiologist or telemedicine service The specialist can open the images in the case and can send reports back to your practice You can create cases or add images to cases from the Patient Clipboard the Image Explorer window or the Image Viewer window When you use the case feature to submit a case to a telemedicine provider you can see the status of the submission on the Image Explorer and when a report comes back from the provider you are able t
155. e Explorer or the Imaging Dashboard 2 2 About the Image Explorer The Image Explorer window allows you to search for images and to begin imaging tasks for selected images e To display the Image Explorer for an image series belonging to a particular patient right click the image series in the Patient History area on the Patient Clipboard and select Image Explorer e To display the Image Explorer without any client or patient information select Activities gt Image 13 Chapter 2 Program Basics Explorer from the menu at the top of the window or click the Image Explorer button Wl on the toolbar In the upper left corner of the window choose either the Quick Search tab or the Advanced Search tab to display the version of the search area you want The parts of the Image Explorer window work together as follows The Toolbar buttons let you display specialized windows such as the Patient List and Client List windows lesmi EEN s A l Toolbar _ _________ Ln m mar eart imh Aera Hi ere m SE p The Search area lets you enter search CELESTA E EFT LLAFE EA criteria eet The Summary List area lists the clients search area ss eve SS SD patients and dates that match your aa ae roc prh WN ee ntormation search ae a ete COD f aa area The Results Detail area shows image Summary List thumbnails for the patient or date thatis selected from the Summary List Results Detail f E area The Information area shows ba
156. e IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software You can set up presets to quickly apply new window and level contrast and brightness settings to an image in the Image Viewer For more information on creating and editing presets see 8 10 Setting Up Window Level Presets 5 11 1 About Window and Level Contrast and Brightness When Cornerstone processes the image it reviews the context of the image and uses parameters defined by exam type to create the default look of the image The image might need to be adjusted due to differences in collimation and variations in exposure and size Use the Window Level tool to tune your images before clicking the Done Capture button The window of an image indicates how much contrast will be in the image A small window between 500 and 2000 will show high contrast but some bone or lung detail may appear washed out and 62 Chapter 5 Reviewing Images be difficult to see With a very large window around 5 000 or 10 000 an image will be flat and very evenly gray The level sets the center point where the image changes from white to black similar to the brightness adjustment on a TV Changing the level makes the overall image lighter or darker and allows you to see detail in different areas of the image For most images the level will average around 8000 The most frequent use of the Window Level tool is to
157. e Image Request special action can be set up for an item on the Invoice Item Information window s Spec Actions tab 246 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration Note the following when setting up an Image Request special action for an invoice item In order to set up an invoice item to initiate an Image Request special action imaging integration must be activated The Image Request special action can be placed on service type Items only Service must be selected as the item type at the top of the Invoice Item Information window Image Request special actions cannot be attached to invoice items that have linked items on the Link Items tab Only one Image Request special action can be applied to an invoice item To set up an Image Request special action for an invoice item 1 With a service type invoice item open for updating on the Invoice Item Information window click the Spec Actions tab IP eke Hen edo revatios for Src FO Ibs Balin Seskes Radiographs From the Special action drop down list select Image Request Note The When to apply setting is automatically set to Immediately on invoice PVL as this is the only available option for this particular special action oben 2 fir Te Eaa Er Bas Sees Flt arth iris liner lene se EA aP AE a a A To specify the modality type for the imaging system used to fulfill the requests created by this special action s
158. e capture process 1 Inthe Images to Send box which lists the images you have captured select images to send by holding down the CTRL key and clicking the images you want 2 Inthe Remote Servers box select the destination to which you want to send the images If you want to send the images to more than one destination hold down the CTRL key and click the destinations you want 3 Click Send to send the images To check the progress of the images as they are being sent or to pause restart or cancel image sending see 6 4 Using the DICOM Queue 143 Chapter 13 Enhancing and Converting Images 13 1 The Reprocess Tool The Reprocess tool allows you to apply edge enhancement to the image For a detailed discussion see 12 3 Advanced Image Enhancement Reprocessing The reprocess tool is available only for radiographs captured with the IDEXX DR 1417 or IDEXX EquiView Digital Imaging System or with ClearCapture Dx Image Processing Technology In reprocessing magnification and window level brightness and contrast changes are undone and annotations are removed To reprocess an image 1 Click the Reprocess tool A dialog box appears with a reminder that you will lose all modifications that have been made to the image 2 Click Yes The Reprocess dialog box appears If you are using ClearCapture Dx Image Processing select a body part if necessary and preset and click OK 4 Ifyou are using standard
159. e handles one red and one green Click on either of these handles and drag to rotate line 3 around the center point As you rotate line 3 the TPLO angle measurement changes Click anywhere on the line and drag to move the line Note When you click on one of the handles so that you can rotate a line the pointer appears as a pointing hand When you click on one of the lines to move it the pointer appears as a four way arrow TIP After you click the TPLO tool click on the image at a point as close as possible to where you want the center point 5 2 2 The Norberg Angle Tool This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography of the template to be This limits module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone the number of line adjustments software you need to make to move the The Norberg angle tool places a template on the image which you can adjust to determine the template into place Norberg angle The Norberg angle is used to assess hip dysplasia and hip laxity 51 To calculate the Norberg angle 1 On the Image Viewer toolbar click Annotate Place the mouse pointer in the center of one femoral head and click Place the mouse pointer in the center of the second femoral head and click The Norberg angle template appears with the default Norberg angles for each hip 0 shown near the femoral head circles and the default combined Norberg angle
160. e humidity 15 to 76 5 to 86 18 14 Caution Regarding Small Detail Object Imaging As with all digital imaging devices there is the potential that small detail structures including high contrast edge structures and fine line structures with a repeating pattern could appear differently in the digital image than in an image created with an analog device such as a screen film system or with another digital device having smaller individual detector elements For example for a sharp edged object the edges of that object may appear to have stair steps when in fact the object edge does not have such structure This is an effect of digital under sampling For small detail objects having a size on the same order of magnitude as an individual pixel or smaller the apparent contrast of that object can vary based on the position relative to the individual detector element locations For example the contrast of a single spherical object the same size as a pixel would have a dramatically different appearance if the object were imaged directly overlying a detector element highest contrast or placed at the intersection of four detector elements lowest contrast Objects inherently smaller than an individual pixel have a radiation intensity signal over an area larger than the small object In each case a lower apparent signal to noise can result in reduced visibility of such objects 901 Chapter 19 The IDEXX EquiView Digital Imaging system
161. e or more images e Send an image with DICOM e Print an image e DICOM print an image e Save an image with the Save As feature Note See the following section for some exceptions to this list At the start of any of these activities a dialog box appears with check boxes in which you can select to apply annotations and to apply overlays To set up these check boxes so that they are selected by default see step 6 in 8 7 Setting Up Imaging 6 6 1 Overlays and DICOM If you create a DICOM file of an image the DICOM header holds much of the same information that is displayed in the overlays For this reason overlays are not applied to the image whenever you e DICOM print an image e Email an image as a DICOM file e Send an image with DICOM e Save an image in the DICOM DCM format using the Save As feature e Send a case with DICOM By default Cornerstone sends the original version of the radiograph as it looked when you clicked Done Capture at the end of the capture process or when you imported or received the file Changes made on the Image Viewer window such as annotations and window level adjustments are not part of the DICOM image that is sent If you want to send the current version of the DICOM image 82 Chapter 6 Distributing Images and Using DICOM rather than the original version contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Although a DICOM ima
162. e patient To compare images for the same patient 1 In the Image Explorer hold down the CTRL key and click on the thumbnails of the images that you want to compare Right click one of the thumbnails and select Compare or click the Compare button The images you selected are displayed together in the Image Viewer To compare images for multiple patients Ts In the Image Explorer click the thumbnail of the image that you want from the first patient If you want more than one image from this animal hold down the CTRL key and click the thumbnails Click the Add to Workspace button or right click one of the thumbnails and then select Add to Workspace Copies of the thumbnails appear in the Workspace area at the bottom of the Image Explorer window Use the Search area to find the next patient for which you want to select images See 2 2 1 The Search Area Quick Search Tab and 2 2 2 The Search Area Advanced Search Tab for more information on using these tabs Chapter 5 Reviewing Images F maneia Tie EE bmm Lih Go Brveriiory Took Inet Sein She rei itt ee eee ks eae eon Ree ok Pe E y inky ee eee FE mage upka a ik de oak eh ind Sass Dim h ik Dika ammi Cet ees Fee hin ce ae bri De paan fis 2 a Dular haaras Pit Bete IE prr C r ra E I ibik E al Bays B22 oe FP eae EH id ast krma eraa Di i Fiun a j ab J Bimby Haja PLIES vce pi iret Trimis Pere hl
163. e product does not operate properly or fails to respond to the controls as described in this manual Follow the safety precautions as specified in this manual Figure 18 14 The IDEXX I Vision CR system scanner Certification and Identification Label stop using the unit and prevent any changes to it Contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Important When the IDEXX I Vision CR system is not in use disconnect power cable from electrical outlet Follow these guidelines This product is designed and manufactured to ensure maximum safety of operation Operate and maintain it in strict compliance with the safety precautions and operating instructions contained in this manual This product meets all the safety requirements applicable to medical equipment However anyone attempting to operate the system must be fully aware of potential safety hazards e Aside from phosphor screen cleaning and the system s rollers cleaning there are no user serviceable parts in this system The product must be installed maintained and serviced by qualified service personnel according to procedures and preventive maintenance schedules in the product service manual If your product does not operate as expected contact your IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 483 9948 190 Chapter 18 The IDEXX I Vision CR Digital Imaging System D
164. e room on the hard disk by removing images that are unlikely to be used such as older images Unlike backing up which makes copies of images archiving removes the primary image files from the Cornerstone Practice Management System Archived images can be brought back into the program if needed Bit The most basic building block of binary data a bit is used to store information The more bits per pixel per color type RGB or grayscale the greater the detail of the image Cases Cases allow you to send a patient s images along with comments and medical history via email Capture Station A computer where radiographs are captured Compression Compression is the process of condensing images for the purpose of saving Space and decreasing transfer times when transmitting images via the Internet DICOM DICOM is an acronym for Digital Imaging and Communications in Medicine a standard method for transferring images and associated information between devices created by different manufacturers Image An image is a graphical picture such as a radiograph 269 Glossary Image Record The image record consists of a thumbnail view of the image the image title the type of image the source of the image the responsible staff member keywords comments about the image compression information bit depth and status Network A group of computers connected together to share resources and work more efficiently In a net
165. echnique chart is set up by weight rather than thickness Contact IDEXX Digital Imaging Support at 1 877 433 9948 Note Technique prompt is not available for mobile laptops or for IDEXX CR 1417 systems that do not have ClearCapture Dx software installed Capture 11 2 1 Viewing Technique Prompt Figure 11 5 The technique prompt and measurement To view the suggested technique for a radiograph you are about to take range buttons gt On the right side of the Image Capture window select the weight of the patient or the thickness of the body part to be radiographed The kVp and mAs for that view appear in large numbers above the thickness selection area 132 Chapter 11 Image Coach and Other Tools 11 2 2 Setting Up the Technique Prompt To enter technique values into Cornerstone see 14 6 Entering Values to Set Up the Technique Prompt 11 3 Dynamic Shot Tree Features for Capture The shot tree on the Capture window has been designed to make it easy for you to capture images in the most convenient order and to allow you to take additional radiographs as needed When you click an exam type and highlight it you select it as the next image that will be captured Once the image is captured it is checked off and the next exam type in the list is automatically highlighted If there are any exam types still unchecked when you reach the bottom of the list the IDEXX Cornerstone Practice Management System highlights the first
166. ed Done Capture at the end of the capture process or when you imported or received the file Changes made on the Image Viewer window such as annotations and window level adjustments are not part of the DICOM image that is sent If you want to send the current version of the DICOM image rather than the original version contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 To send images series or studies via DICOM 1 On the Patient Clipboard in the Patient History area right click the image series and select Image Explorer 2 select the images you want to send and click Send DICOM 74 3 Chapter 6 Distributing Images and Using DICOM Do the following e Select Image to send only the images you have selected e Select Series to send the series to which the selected images belong e Select Study to send the study to which the selected images belong Note For more information about image series and study see 2 3 About Image Series and Study Click Select The Send DICOM dialog box appears The Images to Send list shows the images you have selected In the Remote Servers box select the destination to which you want to send the images If you want to send the images to more than one destination hold down the CTRL key and click on the destination that you want to select Click Send to send the images To check the progress of the images as they are bein
167. ed either at the bottom of the Image Viewer or along the left or right side of the window You can also hide the thumbnail pane when you do not need it Moving or hiding the thumbnail pane allows you to make the best use of the space in the Image Viewer so that the image in the main window is as large as possible You can use the Thumbnail pane to select an image to display in the main window 54 To change the image that is displayed in the main window of the Image Viewer gt Double click the thumbnail for the image that you want to see displayed in the main window The thumbnail you have selected is outlined in red and that image appears in the main Image Viewer window 5 3 2 Using the Thumbnail Pane to Move Around within an Image When you have zoomed in so that the image is larger than the main Image Viewer window you can use the thumbnail to choose which part of the image is displayed To use the thumbnail to move within the main image gt he small blue rectangle within the thumbnail shows the section of the image that is currently shown in the main Image Viewer window Click inside the rectangle and drag it within the thumbnail In the main window the corresponding part of the image is displayed To move the Thumbnail pane gt Click on the bar at the top of the Thumbnail pane and hold down the left mouse button while you drag it to the new position A dark gray outline shows where the Thumbnail pane will be when you rele
168. ed on the patients 19 10 8 Power Cord Safety Information When operating the digital x ray detector a certified detachable power supply cord AN must be used and comply with the following criteria CAUTION To meet applicable U S regulatory agency requirements use the power cord supplied with the EquiView system which meets the following criteria Cord 219 Chapter 19 The IDEXX EquiView Digital Imaging System e Type SJT e Minimum No 18 AWG wire e 3 conductor wire e Rated minimum 10 Amps 125V e Maximum length of 13 ft 4 m Plug e Molded on grounding type attachment plug e Listed Hospital Grade e Either 120V NEMA 5 15P or 240V NEMA 6 15 type 19 10 9 Mechanical Safety Information e Ensure that the patient is suitably restrained in accordance with accepted standards for administration of treatment e This is a portable mobile device Carry it carefully 19 11 Caution Regarding Small Detail Object Imaging As with all digital imaging devices there is the potential that small detail structures high contrast edge structures and fine line structures with a repeating pattern could appear differently in the digital image than in an image created with an analog device such as a screen film system or with another digital device having smaller individual detector elements For example for a sharp edged object the edges of that object may appear to have stair step when in fact the object edge does
169. eens After each image is scanned from a cassette the screen is automatically erased so that it is ready to accept the next x ray image Although the imaging screen is encased in a protective cassette over time the unused screen absorbs radiation that exists naturally in the surrounding atmosphere You should use the scanner to erase the screen manually if e The cassette has not been used in several days e A scan was stopped while only partially completed by clicking Abort from the scanner interface window 183 Chapter 18 The IDEXX I Vision CR Digital Imaging System The process you use to erase screens is slightly different depending on the scanner driver software that is installed with your IDEXX I Vision CR System e lf your system was installed using Cornerstone 8 3 or higher you are probably using the new scanner software Follow the instructions for the newer scanner software below e lf you are using the Windows 7 operating system and have updated your Cornerstone software to version 8 3 or higher you can contact IDEXX Digital Imaging Support if you wish to upgrade to the new scanner software With the upgrade you will no longer need to reselect the view on the blue scanner interface window as part of the capture process Follow the instructions for the newer scanner software below e lf you have not updated your Cornerstone software to version 8 3 or higher or are using the Windows XP operating system the image captu
170. efective components can lead to an increased safety risk 205 Chapter 19 The IDEXX EquiView Digital Imaging System Interval Scope Method Daily Damaged parts inscriptions warning signs Inspection Daily Damage or breaks in any cables or connection Inspection Daily Water leaks unusual noises Inspection Daily Detector plate self test as described in Turn system on and observe following procedure To perform the detector plate self test 1 Turn on the power to the EquiView system The detector initiates a series of self tests 2 Observe the LED on the black box e fthe LED is green the detector has passed the self tests After the 30 minute warmup period use the system as normal e fthe LED is blinking orange red an error occurred in one of the self tests Contact IDEXX customer support before using the system In the U S or Canada call 1 877 433 9948 19 5 Servicing servicing of the EquiView system may be carried out only by personnel authorized by IDEXX The correct setting of the electromechanical and electronic components affects system function image quality electrical safety and the radiation exposure of patients and medical personnel IDEXX recommends that you e Carry out the inspections indicated in the above table on a regular basis e Have the device serviced at least once a year by IDEXX Devices used very often may need to be serviced more frequently A service contract with IDEXX helps you preserve the
171. effect of digital under sampling For small detail objects having a size on the same order of magnitude as an individual pixel or smaller the apparent contrast of that object can vary based on the position relative to the individual detector element locations For example the contrast of a single spherical object the same size as a pixel would have a dramatically different appearance if the object were imaged directly overlying a detector element highest contrast than it would if placed at the intersection of four detector elements lowest contrast Objects inherently smaller than an individual pixel have a radiation intensity signal over an area larger than the small object In each case a lower apparent signal to noise can result in reduced visibility of such objects The table below shows how the LEDs on the box are illuminated to indicate the state of the system and or to indicate what action you can take 228 Chapter 21 The IDEXX DR Relay Box 21 1 Hardware Description The IDEXX DR Relay Box may be part of your IDEXX DR Digital Imaging System See 15 3 Equipment Diagram to see how the box is connected to the system The relay box provides An interface between the following components e The foot switch or hand switch you use to prep and expose e The DR controller box e The generator s prep expose circuit e A visual display of system status during operation e Electrical isolation between the x ray generator and
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173. el image sending See 6 4 Using the DICOM Queue for directions To set up auto routing 1 On the Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select DICOM Services and then select Auto Routing 3 Under the Auto Routing Mode heading in the upper left corner select the radio button next to the type of auto routing you want to use 4 Inthe Remote Servers box select the destination or destinations where images should be sent 5 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 14 3 Setting up Exam Trees If you want to add customized exam type collections or new individual exam types to the Choose Exam Type menu that is used during the image capture process contact IDEXX customer support For service within the United States or Canada call 1 877 433 9948 We strongly recommend that you do not adjust any of the settings on Exam Trees section of the Imaging Configuration window without consulting IDEXX customer support and backing up your existing exam tree 14 4 Setting Up Global Settings The settings in the Global Settings section of the Imaging Configuration window control several features which appear in more than one part of DICOM Imaging 14 4 1 Setting Up the Plate Handle Locator The plate handle locator displays a marker on images that you capture to show the orientation of the detector plate T
174. el text box 4 Ifyou want to change window and level values relative to their current settings select Relative in the Type text box e Jo increase or decrease values in the Window contrast text box enter percentage values that are greater or less than 100 For instance typing 110 in the Window text box increases the window value by 10 while typing 90 lowers it by 10 e To increase or decrease values in the Level Shift brightness text box tyoe the number that you want to be added to or subtracted from the current level value For instance typing 500 adds 500 hundred to the current level value while typing 500 subtracts 500 5 Click Save The Presets Configuration Detail dialog box closes and the new preset is added to the list of available presets 13 3 Reprocessing Reverting and Undoing Changes Cornerstone offers you several ways to return your image to an earlier state The Revert to Original tool returns the image to the way it looked when you clicked Done Capture at the end of capturing the image Any annotations or other changes you made to the image are removed If you want to undo changes made while working in the Image Viewer simply close the Image Viewer without saving When you open the image again in the Image Viewer the image looks the way it did the last time you saved tt If you want to undo changes you made to window and level contrast and brightness since the last time you saved this image click Window Leve
175. elect a fraction of a second e Exposure kVp lype the amount of voltage peak kilovoltage used for this image e Use of Grid Select the check box if a grid was used eee EE image mersi Ey e Level of sedation Select from the drop down menu Imege Catala Teihregar Lev Lents Click the OK to save the information and close the dialog box butane Thinkin aika On the Image Viewer window click Save and select Save fromthe coos a drop down menu ia ae ma Ped Fapeduee bp baal ciel ated ali 5 14 Using Full Screen Mode e awaka v Cura of en When the Image Viewer window is in full screen mode the toolbar and the Thumbnail pane are hidden so that the image is displayed as large as possible on your screen To turn full screen mode on and off 1 Press the F11 key to turn on full screen mode 2 Press the F11 key or the ESC key to return the Image Viewer window to normal mode with the toolbar and Thumbnail pane displayed To use the Image Viewer tools in full screen mode a i 1 Press the F10 key to display a menu of Image Viewer tools in the m upper right corner of the screen Figure 5 8 The Technique Details tab on the Image Details dialog box 2 select a tool from the menu The tools work as they do in Image Viewer window in normal mode 5 15 Viewing Dental Images This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic
176. elect a type code in the Modality text box If an IDEXX Digital Imaging system will be used and you want to select shots to be associated with this item by default do the following a Click the Shot Selection icon The Shot Selection dialog box appears Note The Shot Selection icon displays as a shot tree with a sign tae if shots have not been added for the item and as a standard shot tree Figure 22 2 The Image Invoice Item dialog box no sign if shots have already been selected for this invoice item b Select all image shots to be associated with this invoice item by default then click OK to return to the invoice item s Spec Actions tab See 22 5 3 Selecting Image Shots on the Shot selection Dialog Box for more information on selecting image shots Note You are not required to select default image shots for the item during setup If desired you can set up the invoice item with no shots selected and instead add request notes in 247 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration the Exam Description text box so the technician can select the shots when completing the request 5 If you want specific request notes to display with this invoice item by default when an image request is made for this item in the Exam Desc text box type a brief description up to 64 characters of the shots to be taken Tip To specify whether staff with security privileges
177. elect an address 1 2 Select the row in the table for the email address you want If you want to select more than one address hold down CTRL while you click Click OK The Address Book dialog box closes and the email address appears in the To text box To set up addresses NOD p e eS oS Click Add Email Address A new row appears in the table Click the new row In the Description text box type a name for this email address In the Email Address text box type the address Click Save Repeat steps 2 5 for each address you want to enter When you have finished entering addresses click Close to close the dialog box 81 6 6 Applying Annotations and Overlays Whenever you send an image out of Cornerstone you have the choice of adding two kinds of information e Annotations are elements that you add to the Chapter 6 Distributing Images and Using DICOM TIP Annotations or overlays become a permanent part of an image that is sent or saved from Cornerstone However you can always change the annotations and overlays that are displayed on the image within the software image in the Image Viewer such as arrows text and measurements e Overlays are information that is stored in Cornerstone such as patient name patient date of birth image name series name and the date and time that the image was taken You have the choice to apply annotations and overlays whenever you e Create a patient CD e Email on
178. em use the instructions in chapter 15 If you have an IDEXX CR 1417 system the oval IDEXX label on the front of your scanner identifies it as either the Model 140 or the Model 140R 17 1 Background The IDEXX CR 1417 system scanner Model 140 or 140R uses a phosphor screen with energy storage capability as an x ray image receptor The imaging screen is contained inside a cassette Three sizes of cassettes can be used with the scanner 14x 17 10x 12 and 8 x 10 After exposure the cassette is loaded into the scanner A laser beam which stimulates luminescence proportional to the x ray exposure scans the screen The luminescence signal is digitized and the exposure data is then passed to digital image processing The screen is then erased with white light Note The only time a screen is out of the cassette is when the IDEXX CR 1417 system scanner automatically loads the screen for scanning The Cornerstone Practice Management Software is designed for use with the IDEXX CR 1417 Piguet talk Front view of scanner system scanner Knowledge of basic computer functions is required to operate the software and scanner l CYN 17 2 The IDEXX CR 1417 Scanner Your IDEXX representative will set up your IDEXX CR 1417 system scanner for you However you need to be familiar with the various components of the IDEXX CR 1417 system scanner before operating it Power Switch Figures 17 1 and 17 2 show front and
179. em description invoice item ID and invoice item modality e Range options include invoice item description invoice item ID and invoice item modality Note The Image Request Special Action Item Report allows you to view all imaging invoice items in a single list This report listing should be used as your reference for all imaging invoice items and their associated image shots versus viewing the items on the Imaging Invoice Item Maintenance window that was previously available in Cornerstone versions before 8 2 293 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration 22 5 7 Charging for Not Requested Images Images that are taken but are not part of a request appear on the Image List screen with a status of Not Requested On the Not Requested Image window you can choose whether or not you want to bill for an image that was not requested in the requisition If a Not Requested image is not assigned to the proper patient this is not common you can reassign the image To resolve a Not Requested image 1 Onthe Image Requests and Results dialog box select a Not Requested image and click Update The Not Requested Image for dialog box appears 2 Ifyou need to look at the image to be able to decide whether you want to bill the client for it click View to open the Image Viewer BP tor Frgueerted lrigge ter Magee Blue 03 1 Note The number of images and their capture dates are shown on the Not
180. emplate Note If you add a third handle the circle is redrawn so that it passes through all three handle points The circle is adjusted as you click and drag any of the handles To adjust a circle for the best fit to an irregular area such as a deformed femoral head click to add points along the edge of the femoral head Cornerstone redraws the circle to be the closest possible fit to the points and moves the center point appropriately You can have up to 10 points around the circle long the heart is and how many vertebrae wide The sum of the two measurements is the VHS Figure 5 3 An example of the VHS tool in use 52 Chapter 5 Reviewing Images Measure the length of the heart on the radiograph from the cranioventral border of carina to the Cardiac apex Find the width at the widest point on the cardiac image using a line perpendicular to the first line The measurement on the thoracic vertebra should start from the cranial edge of the T4 vertebra and move in a caudal direction When you ve made these measurements you are able to determine the length and width of the heart in vertebral units to one decimal place The sum of the length and width is the VHS To use the VHS tool 1 Open a thoracic lateral radiograph in the Image Viewer uh _ La g Gi 2 Click Annotate then select Vertebral Heart Score Two sets of lines appear on the image a pair of crossed lines for measuring the heart and a set of three
181. en select Manufacturer Mapping From the Manufacturers drop down list select the manufacturer From the Modalities drop down list select the modality e g computer radiography magnetic resonance ultrasound for which you are mapping fields 5 Click Add to add a new row of data for the selected manufacturer modality Using the conformance statements for the local DICOM server and the selected device enter the following information for each text box one row per field as needed e Group This is the group number assigned to a selected text box for the local DICOM server 98 Chapter 8 Setting Up Basic Imaging Features Element This is the element number assigned to a selected text box for the local DICOM server Mfr Group This is the group number assigned to a selected text box by the device s manufacturer Mfr Element This is the element number assigned to a selected text box by the device s manufacturer Default This is the default value assigned to a selected text box by the device s manufacturer Override This is the value that the local DICOM server will use to replace the device manufacturer s default value Note To delete a row select it and then click the Delete button Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 4 Setting Up Imaging Email You can now set up the email feature within DICOM Imaging so that it will send ema
182. ere in the clinic then select the capture request on your radiology workstation The requested shots are preselected Note For more information about SmartLink technology and about different ways to create an image capture request see Chapter 22 Using IDEXX SmartLink Digital Imaging and Modality Worklist Integration To choose radiographs exam types using a capture request 1 Onthe Image Request and Results screen find and select the image request you want and then click Capture Images Note You can also start on the Imaging Dashboard screen Click to select a request in the Open Requests list and then click Capture Images or just double click the request The Capture Setup window appears with the exam types for the request already selected in the Choose Exam Type area 117 Chapter 10 Capturing Images 2 At the top of the window your user name should be displayed in the Technician text box but you can choose a different name from the drop down menu 3 The Veterinarian text box should display the name of the veterinarian for whom you are capturing the images but you can choose a different name from the drop down menu Chest Erem Tre 4 Click Next to display the Ready for Capture window The first radiograph in the request Is kenem highlighted in the shot tree menu on the right a Miras emi E IE aE i 5 To capture the images follow the instructions later in this chapter that apply to your IDEXX Digital Im
183. ervice level you elect Please refer to our extended maintenance agreement terms for a complete description Defective components that influence the device s safety must be replaced by original spare parts Note There are no user serviceable components within the IDEXX DR 1417 system All service is Subject to the terms of the IDEXX Warranty or Maintenance and Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 15 6 Repair Defective components that influence the device s safety must be replaced by original spare parts 15 7 Technical Specifications Detector type Direct conversion TFT amorphous selenium Detecting area 14 x 17 856 mm x 427 mm Matrix resolution 2560 x 3072 7 8 M Pixel size 139 um x 139 um Bit depth 14 bits Individual image size Storage 15 MB standard monitor Color 1600 x 1200 display Optional monitor 21 3 2 MP Gray scale can upgrade to 3 MP 15 8 Environmental Conditions The detector panel and black box control box are designed to operate properly in normal living environments The requirements related to the operation storage and transit of these components are shown in the rest of this section Note For better quality images do not place anything on top of the detector plate 195 Chapter 15 The IDEXX DR 1417 Digital Imaging System Operating Environment Ambient temperature 50 F to 95
184. es you can move radiographs from one cell to another either within the same pane or between one pane and the other When 68 Chapter 5 Reviewing Images you move a radiograph to a cell that is already occupied you bump the radiograph that is currently in the cell to the last overflow cell the cell that is furthest down and to the right in the overflow pane To place a radiograph in a cell 1 2 Click the image and drag it to the cell you want Let go of the mouse button when the cell turns white The radiograph you moved now occupies that cell Note If the cell was already occupied the radiograph that had occupied the cell is moved to the last overflow cell To remove a radiograph from the template layout gt Click the radiograph drag it to the overflow pane and let go of the mouse button Note If you let go of the mouse button when the radiograph is between cells in the overflow pane no cell turns white the radiograph you are moving is placed in the last overflow cell To save the current arrangement of radiographs within the template gt Click Save 5 and select Save Study or click Close in the upper right corner to close the Image Viewer and then select Yes in the dialog box that appears The next time you view this series of dental radiographs in the Image Viewer all the radiographs will be displayed in the same cells To save a customized template layout Click Save and select Save Temp
185. es a complete set of advanced image enhancement tools o Client invoicing o Client patient and case management e Be aware that the capture software stores a copy of your images for a limited time only All long term storage is in the Cornerstone database 118 Chapter 10 Capturing Images To capture images when both Cornerstone 8 3 and capture software are installed on the same radiology workstation This is the typical configuration at most practices gt Start the capture request from Cornerstone software following the instructions in section 10 2 above To capture images if Cornerstone is available only over the network 1 Start the image request on any Cornerstone workstation networked with your radiology computer Cornerstone sends the request to the capture software On the radiology workstation start the capture software and select the Modality Worklist tab Click Search using the default search parameters All current Cornerstone image requests are displayed Select the request you want and then click Capture Images At the top of the window your user name should be displayed in the Technician text box but you can choose a different name from the drop down menu 6 The Veterinarian text box should display the name of the veterinarian for whom you are capturing the images but you can choose a different name from the drop down menu 7 Click Next and then follow the instructions later in this chapter that
186. es in Imaging defaults See 22 4 2 Setting Up Imaging Integration Defaults for information 3 Create new service type imaging invoice items that use the Image Request special action to link multiple shots or a series of shots to each item See 22 4 3 Setting Up Invoice Items to Initiate Image Request Special Actions for information 4 Delete or mark many of your current single shot imaging items as Inactive as these invoice items will not be needed going forward 22 3 Imaging Integration Setup Examples Using special actions you can set up imaging integration in many different ways depending on how you prefer to order and bill for radiographs To help you envision different uses here are examples of a few ways you can set up and use SmartLink Digital Imaging One key to remember is that in Cornerstone 8 2 SmartLink Digital Imaging creates billing based on groups of images not individual images Consider the following when you decide how to set up and use your imaging invoice items e If you select specific views at the time of the request this enables you to better capture missed charges Any shots that are taken beyond those specified will be marked as Not Requested shots See 22 5 7 Charging for Not Requested Images e If you do NOT select views at the time of the request this gives you more freedom in situations when the exact shots are not known at the time of the request A request with no specific shots
187. esentative will set up your IDEXX CR 1417 system for you However you need to be familiar with the various components of the IDEXX CR 1417 system scanner before operating It Be sure to read the Safety Information section Power Connector Is where the AC power cable plugs into the reader Power Switch Turns the reader on off USB Connector Connects the reader to the computer via a USB cable Cassette Tray Inserts the cassette into the reader for reading and erasing the imaging plates System LED Indicates the status of the reader Process LED Indicates the status of the reader 16 2 1 Reader Status Indicators There are two LED status indicators located on the front of the IDEXX CR 1417 system scanner above the cassette tray e The left LED indicates the status of the system STS SSI e The right LED indicates the status of the process Each indicator can appear green orange or red and the color can be either constant or blinking The colors indicate the following ee System LED Process LED e Green Ready L gt e Orange System is busy please wait e Red Error correct the problem before using the OT reader aE lt Cassette Tray os Figure 16 2 The IDEXX CR 1417 system scanner front 164 Reader Status Off Powering Up Powering Up Power On Loading the Screen Done Loading Reading the Screen Erasing the Screen Ejecting the Screen Finished Error System
188. eset from the Image Viewer ccccccccccccccccccccccsccccccccececesesesecssseeseeeeeeeeeeees 145 13 3 Reprocessing Reverting and Undoing Changes ssssssssseeeerererrrerrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrena 145 13 4 Converting Images Captured in Older Versions of COrnerstone esssssssssiiiiiiiiriirreereerrrrrrrrrrrrrrrn 146 Chapter 14 Setting Up IDEXX Digital Imaging System Features ccssesesseeeseeeeeeeeeees 147 14 1 Setting Up Dashboard Window Lists ccccccccsessesesesessseeseseeeseeeeeseeesenseessetseseeseeetereceeeeeeeeeeeeeeeeees 147 HA ee ITI Ae UO WAC ereraa SESE enadanosonadedodans qrauencenesueeceesiecseestaraternsenaieee 147 IAS voina Up Exam MOOS ee een rece ene Mee ee eae eRe RE Ee Sen oe I rT RT Se eT ee te eee eee ere 148 144 Setting Up Global Settings siscecetenetes otetetclexstereiacedavauatdnavduatanaydgeagasegecdgsseieccasueneneneneeupeeeeeubeniadaniainadaninate 148 14 4 1 Setting Up the Plate Handle Locator eeeeeseesesssssssssseennrrrrrrrnrrrererrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrna 148 14 4 2 Setting Up Secure Image Display cccccscssssssssssssssssccccccccceccscccsssececccscsesssssscesseesesesesesesee ss 149 14 4 3 Setting Up Single Species Mode cccccesssscscscssscsccccscnecccccccccesecesscseeceeesceeeeesseesesseseesseseeeeeesss 149 14 5 Setting Up System Type isccicsaiccsiarstezsieeeietececeletedasdwasdvandnavavasadsagasiasdaassdeacdaganneen
189. ess the x ray generator will expose just as if you were taking a radiograph Observe all the cautions you would when taking any radiograph including but not limited to wearing appropriate protective garments and dosimeter and staying out of the path of the x ray beam 231 Chapter 21 The IDEXX DR Relay Box 1 On the front of the relay box use the tip of a pen or pencil to press the switch to the left of the Test LED The LED should turn green 2 While still pressing the Test switch press the foot or hand switch as you usually do to prep the system The Test LED should blink now but still be green 3 While still pressing the Test switch press the foot or hand switch as you usually do to expose The yellow X Ray Exposure LED should be on exposure 4 Release the Test switch and foot or hand switch 21 5 Technical Cleaning and Safety Information For your protection and for the protection of the equipment use the IDEXX DR Relay Box scanner only in the manner outlined in this operator s guide The relay box is designed for use with generators for which the switch voltage and current are below either 30VDC 1A or 240VAC 4A Observe the following e Do not allow the DR Relay Box to be immersed in water or fluids e Protect from splashing by mopping spills or animal waste e Do not pull on wires or allow wires to become entangled e Protect the wires from chewing by animals e No user serviceable parts are inside 21
190. esthetic mixture with air oxygen or nitrous oxide The detector panel must not be carried by its connecting cable Note Follow all safety labels on the equipment 20 9 7 Sealed System Safety and Cleaning Information The detector panel is sealed so that biological fluids will not penetrate the outer casing during normal use The exterior of the plate carbon panel can be cleaned with common decontamination solutions including 20 chlorine bleach solution 1 part bleach to 4 parts water A 5 gluteraldehyde or 70 alcohol solution can also be used To apply the cleaning solution power down the system and disconnect from power source moisten a cloth with the solution and wipe the panel Note The user must follow standard cleaning and decontamination policies and procedures Do not spray cleaning solution directly onto the panel Instead moisten a cloth with the solution and wipe the panel CAUTION 226 Chapter 20 The IDEXX I Vision DR System E Do not immerse the panel in liquid Do not autoclave the panel CAUTION 20 9 8 Electrical Safety Information DO NOT OPERATE THE IDEXX I VISION DR SYSTEM UNDER THE FOLLOWING CONDITIONS iai e Do not operate the system in potentially explosive atmospheres e Do not operate the system in the presence of potentially explosive gas mixtures such as those that can form when cleaning agents disinfectants flammable anesthetic material skin cleaners oxygen and some coupling
191. external Drive DVD CD 8X DVD RW Monitor 14 1 1280 x 800 Gigabit Ethernet Operating system Windows XP Professional 19 9 Environmental Conditions The detector panel and black box control box are designed to operate properly in normal living environments The requirements related to the operation storage and transit of these components are shown in the rest of this section Note For better quality images do not place anything on top of the detector plate Operating Environment Ambient temperature 50 F to 95 F 10 C to 35 C Relative air humidity 20 to 75 RH noncondensing Max rate of change lt 18 F 10 C per hour Pressure range 500 to 1060 hPa Note The EquiView system must not be operated in conditions under which condensation can form in the device Operate the device only under the environmental conditions described above 210 Chapter 19 The IDEXX EquiView Digital Imaging System Storage Environment Temperature 50 F to 104 F 5 C to 40 C Relative air humidity 5 to 95 RH noncondensing Max rate of change lt 27 F 15 C per hour Pressure range 500 to 1060 hPa Transit Environment Temperature detector plate 50 F to 95 F 5 C to 40 C Temperature black box 40 F to 45 F 40 C to 45 C Humidity 5 to 95 RH noncondensing Max rate of change lt 27 F 15 C per hour 19 10 Safety Information 19 10 1 Safety Statement The operator s guide is an integra
192. feature The Help tool displays the online Help in a new window 50 Chapter 5 Reviewing Images 5 2 Special Measurement and Planning Tools 5 2 1 The TPLO Tool This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography Line 1 module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone oo software The TPLO tool places a template on the image which you can adjust to determine the tibial plateau leveling osteotomy TPLO angle The TPLO template is a set of three lines that intersect at a common point See Fig 5 1 for an example Line 2 Line 3 e Line 1 is vertical when the template first appears This is the line that should be aligned with the length of the bone so that it passes through the center of the talus and through the centers of the intercondylar eminencies of the tibia Line one has two small square handles one blue and one green Click on either of these handles and drag to rotate line 1 around the center point Click anywhere on the line and drag to move the line e Line 2 is always perpendicular to line 1 When you move or rotate line 1 line 2 moves and rotates Figure 5 1 An example of the TPLO template with it Note that the Line 1 Line 2 and Line 3 labels are not part of the tool e Line 3 is the line that you move to calculate the TPLO angle which is measured between lines 2 and 3 Line one has two small squar
193. four different versions of a radiograph You also have the ability to reprocess radiographs as discussed in section 12 3 1 Reprocessing with ClearCapture Dx Image Processing 11 6 1 About the Dongle The dongle is a device that resembles a USB flash drive or memory stick The dongle should always be attached to a USB port on the capture station the computer connected to the IDEXX Digital Imaging system It contains security software that lets the IDEXX Digital Imaging system access the special software required for the ClearCapture Dx software Without the dongle an IDEXX CR 1417 system using ClearCapture Dx software will capture radiographs in an unprocessed state and you will not be able to reprocess them An IDEXX I Vision DR or IDEXX DR 1417 system without the dongle will capture radiographs using standard image processing and you will be able to reprocess only using standard image processing When Cornerstone detects that the dongle is missing an error message with further instructions will appear Removing the dongle from the capture station is not recommended 11 7 Sending Images Automatically During Image Capture Auto Routing The IDEXX Cornerstone Practice Management System offers the ability to send images via DICOM automatically at the end of the image capture process For more information about setting up auto routing see 14 2 Setting Up Auto Routing To send images via automatic auto routing gt Ifthe pr
194. ftware will display a message to remind you to clean the rollers The cleaning process requires the following e Acleaning tray e Acleaning plate with adhesive strips covered with protective paper and a protective envelope To order new cleaning plates contact IDEXX Digital Imaging Support In the U S or Canada call 1 877 433 9948 Note The cleaning process is different for the Model 140 than it is for the Model 140R Be sure to follow the proper instructions To clean the rollers 1 Remove any cassettes and screens from the scanner Use the menu at the top of the window to select Tools gt Settings gt System Select Imaging in the navigation menu on the left Click Scanner Configuration Settings aS Sf Type user in the User name text box and idexx123 in the Password text box then click Login After a few seconds the User window appears Note Depending on when your system was installed your password may begin with a lowercase i The Password text box is case sensitive so be sure to make a note of your exact password Insert the cleaning tray by pushing gently until it locks into place See figure 18 9 Remove the protective paper from the cleaning plate to expose the adhesive Save the paper for later 8 Place the cleaning plate on the tray Make sure the cleaning plate is oriented in the direction specified on the plate 9 Inthe Maintenance area if the Dismiss button is active blue click it and then
195. g sent or to pause restart or cancel image sending see 6 4 Using the DICOM Queue To send images series or studies via DICOM from the Image Viewer 1 To select the image that you want to send click the image Thumbnail in the Thumbnail pane so that red borders are displayed around the thumbnail Right click the thumbnail and select Send to from the menu that appears In the Select Action area of the Select Images dialog box select Send DICOM In the Select Image Level area select whether you want to send just this image the whole series to which the image belongs or the entire study to which the image belongs Note For more information about image series and study see 2 3 About Image Series and Study select the Apply annotations check box if you want the image to be sent with the annotations that are visible in the Image Viewer window select the Apply overlays check box if you want the image to be sent with the overlays that are visible in the Image Viewer window Click Select The Send DICOM dialog box appears The Images to Send list shows the images you have selected In the Remote Servers box select the destination to which you want to send the images If you want to send the images to more than one destination hold down the CTRL key and click on the destination that you want to select Click Send to send the images To check the progress of the images as they are being sent or to pause re
196. ge and select a format and a location for the file At the bottom of the Save As dialog box do the following e Select Burn Overlays if you want the images that you email to contain the overlay information displayed in the Image Viewer e Select Burn Annotations if you want the images that you email to contain the annotations created in the Image Viewer Click Save to complete the process Note For a list of the file formats that you can import into Cornerstone see Importing and Acquiring Images from Scanners Ultrasound Digital Cameras etc in chapter 26 of the Cornerstone User s Manual 84 7 2 Reassigning an Image Study A study can be reassigned to a different patient if necessary To reassign a study Te In the Image Explorer select an image from the study you want to assign to a different patient Click Reassign on the right or right click and select Reassign from the pop up menu The Select Patient dialog box appears To find the patient to whom the study will now be assigned type information in the text boxes at the top of the Select Patient dialog box and click Search The search results appear in the table lower down in the dialog box In the table click the patient to whom you want to assign the image record then click the red Select Patient button on the far right The study is moved to the patient you have selected The Image Explorer now shows the patient with all its studies 7 3 Deleting Images o
197. ge on the patient CD cannot have annotations or overlays the JPEG version of the same image can have them if you choose When you display a DICOM image using the viewer that is included on a patient CD information from the DICOM header is displayed the same way the overlays are displayed within the Cornerstone software 6 7 About the CD Writing Process The creation of CDs or DVDs from the Cornerstone software is handled by the IDEXX Media Write Utility The utility is used whenever you create a patient CD export a case to a CD or archive images to a CD When you begin the CD writing process 1 Ifyou are given a choice be sure that the CD DVD option is selected 2 Ifyou see a Number of Copies text box enter the number of copies of this patient CD you want to make During the CD writing process 1 If you want to cancel the CD writing process e The first time you create a patient CD after restarting the Cornerstone software a balloon appears in the lower left of the computer screen Click this balloon and select the option to cancel the CD writing process e For every subsequent CD you create an icon for the IDEXX Media Write Utility appears at the bottom of the screen Click the icon to open the IDEXX Media Write Utility and select Cancel Write 2 lf you want to view the progress of the CD writing process e The first time you create a patient CD after restarting the Cornerstone software a balloon appears in the lower left
198. ged to try to correct the interference by one or more of the following measures e Reorient or relocate the receiving device e Increase the separation distance between the equipment e Connect the equipment into an outlet on a circuit different from that to which the other device s are connected e Contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Classification 1 Class equipment 2 Ordinary equipment 3 Equipment not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide 4 Continuous operation 223 Chapter 20 The IDEXX I Vision DR System 20 9 3 Safety Symbols The following safety related symbol is found in this chapter To avoid injury learn to recognize it A Attention Read the CAUTION or WARNING statement that follows The following safety related symbols are found on the IDEXX I Vision DR System components To avoid injury learn to recognize them O F es 38 Ti 28 5 1 OR 7 b Power on Power off Operating temperature range exposure to temperatures outside of this range could damage equipment or affect performance Storage temperature range exposure to temperatures outside of this range could damage equipment or affect performance Fragile handle with care Special cleaning instructions see 20 9 7 Sealed System Safety and Cleaning Information Do
199. hat must be stored for an image in one file i e data dictionary requirements for the image type options for the image type The DICOM communication protocol based on conformance statements defined for each individual DICOM device defines how information is shared between devices such as computer workstations printers and readers If you have any questions or require assistance as you configure your local DICOM server contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 93 Chapter 8 Setting Up Basic Imaging Features 8 3 1 DICOM Services Configuration at a Glance The first four DICOM configuration selections allow you to set up communication between your local DICOM server and any external device Local Server Configuration This window appears when you open the IDEXX DICOM Services program Use this window to configure your local DICOM server To access this window select Controls gt Defaults gt Imaging and then select DICOM Services and Local Server from the menu on the left Remote Servers Configuration This window allows you to identify the external devices with which the local DICOM server will be communicating Use this window to identify each device s name server address and port number To access this window select Controls gt Defaults gt Imaging and then select DICOM Services and Remote Servers from the menu on the left Manufacturer Configuration and
200. he final step in the image capture process is saving the images To save images gt When you have checked the images and enhanced them as necessary click Done Capture The Image Capture window closes and Cornerstone displays the window from which you started If you started from the Patient Clipboard the image series you have just captured are displayed in the Patient History area If you started from Image Explorer the images you have just taken are displayed as thumbnails within an image study If you started from the Imaging Dashboard the image study or studies you just captured are listed in the Recent Studies list 142 12 5 Sending Images Automatically During Image Capture Auto Routing The IDEXX Cornerstone Practice Management System offers the ability to send images via DICOM automatically at the end of the image capture process For more information about setting up auto routing see 14 2 Setting Up Auto Routing To send images via automatic auto routing gt Ifthe program has been set up for automatic auto routing the images are sent without requiring any user intervention To check the progress of the images as they are being sent or to pause restart or cancel image sending see 6 4 Using the DICOM Queue To send images via semi automatic auto routing If the program has been set up for semi automatic auto routing follow these instructions when the send DICOM dialog box appears at the end of the imag
201. he plate slightly into the scanner The rollers should pull it in almost entirely with a few inches of the plate remaining outside 176 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System IMPORTANT Let go of the cleaning plate as soon as the rollers begin to pull it in Resisting the rollers will damage the scanner 12 Repeat the cleaning process steps 9 11 two more times e Be sure the cleaning tray is locked in place before you start each cleaning cycle e lf the Pull out the cleaning plate and then release the cleaning tray message appears click OK but do not remove the plate until the third cleaning cycle is finished 13 Disconnect the cleaning tray by pulling out the knob underneath the front tray completely until it comes to a stop The scanner performs a reset homing cycle Note If the homing does not occur turn the scanner off and then back on 14 Cover the adhesive area on the cleaning plate with the protective paper and store the cleaning plate in the protective envelope 15 Click OK in the lower right corner of the User window to close it 17 7 Caution Regarding Small Detail Object Imaging As with all digital imaging devices there is the potential that small detail structures including high contrast edge structures and fine line structures with a repeating pattern could appear differently in the digital image than in an image created with an analog device such as a screen film
202. he spray disinfectant Wipe the IDEXX DR 1417 system with disinfectant 15 2 3 Maintenance Maintenance consists of both checks that the operator can perform himself or herself and service performed by IDEXX within the scope of service contracts by service order or by persons expressly authorized by IDEXX to perform such tasks Like all technical devices the IDEXX DR 1417 system requires e Correct operation e Regular inspection by the operator e Regular maintenance and servicing These measures help you maintain the working order and the operational reliability of your device As the operator of the device you must abide by the regulations for prevention of accidents and the local medical product law as well as other regulations 15 3 Equipment Diagram On the following page figures 15 1 and 15 2 show how the various pieces of the IDEXX DR 1417 system can be connected Note Image artifacts may occur if cables are damaged Be careful to keep cables out of walkways to reduce the risk of damage Do not connect cable to the detector panel while power is on or power is flowing CAUTION 192 A The detector panel needs to warm up for 30 minutes prior to use CAUTION Prep and expose sequence black and white boxes To confirm that the equipment has been properly set up check that the lights on the black and white boxes light up in the following sequence 1 When the system is prepped and ready for exposure the light o
203. hird cleaning cycle remove the plate and tray Cover the adhesive area on the cleaning plate with the protective paper and store the cleaning plate in the protective envelope Click OK in the lower right corner of the User window to close it To clean the rollers for the Model 140 1 2 10 11 Remove the cassette and screen from the scanner In Cornerstone use the menu at the top of the window to select Controls gt Defaults gt Imaging and then select Imaging in the navigation menu on the left The Imaging Configuration window appears Click Scanner Configuration Settings The Password dialog box appears Type user in the User name text box and idexx123 in the Password text box then click Login Both the user name and password must be all lowercase After a pause of a few seconds the User window appears Insert the cleaning tray making sure that it locks into place Remove the protective paper from the cleaning plate to expose the adhesive Save the protective paper for later Place the cleaning plate on the tray Make sure the cleaning plate is placed in the correct direction as specified on the plate If you have been seeing cleaning reminders when you use the scanner click Dismiss and then click OK to reset the cleaning reminder In the Maintenance area click Prepare The rollers begin to rotate The System is ready for roller cleaning message appears Click OK While holding on to the plate push t
204. his marker appears as two small squares next to each other one black and one white The plate handle locator marker appears on the image in the corner where the cable attaches to the plate if you are looking at the plate from the front with the handle on the left side this would be the upper left corner 148 Chapter 14 Setting Up IDEXX Digital Imaging System Features To set up the plate handle locator 1 On the Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Global Settings 3 Select the Show Plate Handle Locator check box 4 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 14 4 2 Setting Up Secure Image Display In secure mode the Image Explorer window and the Imaging Dashboard window display only images that you created or if you are a veterinarian images that were created for you as a veterinarian To set up secure mode 1 Onthe Controls menu select Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select Global Settings 3 Select the Enable Client Patient Security check box 4 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 14 4 3 Setting Up Single Species Mode When you enable single species mode only one species and the related breeds are available as choices when you search for patients from the
205. ically filled in when you capture an image based on the exam type group that includes that image The Key Image check box lets you mark this as a key image Key images may be useful if you have a DICOM printer 2 On the left of the Image Details tab are a number of informational fields which cannot be altered as well as three text boxes in which you can change information These are Client Name Patient Name Capture Date the date the image was captured Type a date in the text box or use the drop down calendar to select the date Note The ability to change the capture date is provided so that the proper date can be entered for scanned documents 65 Chapter 5 Reviewing Images e Modified Date the date the image was last changed e Tech Name the name of the person who was logged in to the Cornerstone software when the image was captured e Keywords the keywords that can be used for searching in the Advanced Search tab of the Image Explorer gt Click to select a Keyword or hold down the CTRL key and click to select more than one keyword A set of standard medical and lay terms is provided in this list See 8 8 Setting Up Keywords for Images for information on creating your own new keywords e Veterinarian the veterinarian for whom the image was captured gt Select the name of the veterinarian from the drop down menu On the right side of the dialog box is technical information about how the image was captured
206. icator is a light emitting diode LED located on the front of the IDEXX I Vision CR system scanner to the left of the cassette entry slot To indicate scanner status this LED can appear green or orange and the color can be either steady or blinking Table 19 1 Indicator LED states displayed during scanner operation System Status Indicator Powering up and homing steady Orange brief Ready for scan Steady Green scanning Blinking Green Error Blinking Orange 18 3 IDEXX I Vision CR Imaging Cassettes and Screens The imaging screen for the IDEXX I Vision CR system scanner is contained within a cassette and should remain there for normal use During normal use the only time a screen is out of the cassette is when the scanner automatically loads the screen for reading Note Io ensure proper radiograph orientation place the animal s head over or near the red arrow on the cassette For extremities point the animal s toes away from the red arrow IMPORTANT Use only Kodak or CARESTREAM screens with the IDEXX I Vision CR System These screens are white on one side and black on the other Cassettes for these screens are marked with labels like those shown in Figures 18 3 and 18 4 Figure 18 3 A Carestream GP 2 cassette label Figure 18 4 A Kodak GP 2 cassette label 182 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 3 1 Loading a Cassette To load a cassette into the scanner 1 Be sure that the scanner
207. icking the little upside down triangle in the Priority column and then selecting the new priority from the drop down menu The priority will change immediately for all the images in that series e When you have finished using the DICOM queue click the X in the upper right corner of the DICOM Queue window The window closes 6 4 2 About the Inbound DICOM Queue The inbound DICOM queue displays a table listing images that have been received by the system or are in the process of being received The table organizes the images by series and study Click the sign for a study to see the series within it and click the sign for a series to see the images within it The following information is displayed for each image e Names of the patient and owner client e Date that the image was captured e Names of the study series and image e Sender of the image e Status of the receiving process Each image has a status listed in the Status column e Images with a status of Receiving are in the process of being received You cannot remove images while they are being received e Failed images were not received successfully e Received images have been received completely and can be viewed in Cornerstone Note Be careful not to confuse the Status column with the Status Details column which initially displays as Status To use the inbound DICOM queue e The information displayed by the DICOM queue changes during the receiving process Th
208. ieeeseerieseseent tonka uoe en eo peer riiai iaaa kga Ri 259 23 4 The Screens in Depth i scicscidssacscscesssceeassdadeseds ssnwsnhnnsnndshnnsinunsadsasdassananbasdenesehcnbiecticabiesdendeaastsadeaasadeceadeds 260 2E Ae UU MEN a A T E E aha E 260 23 4 2 Patient SUMMAN cccccssccssscsssssssssssneeeeeeeeeesseeeeeeseeeeeeeeeeeeeeeeeeeeeesssssssssseseeeeseesseesesesseeeseseneeseeens 262 ike We Viewer oala BIOWSOT eR eee eee eee meee one eee Aea rT eT er ee 263 23 4 4 Viewer Dolphin Browser ccccccceceeccssssscccensuesesseecensesceeeeeceeeseensuseesnnesueesceseesesueeessesseneueseesss 267 ake es REGUS OC gt OPAPP rere eee en ee eS ee aE 268 SS ge atte cee ser ee lei acta cao E E E E E EA 269 Customer Support and Information ccceesseeseeeeeseeseeeeeeeeeeeeeeeeeeeeeneeeaeeenseaeaesenseoeseneaesoneens 271 Chapter 1 Introduction 1 1 About this Guide This User s Guide contains information about using the advanced imaging features available in the IDEXX Cornerstone Practice Management System For information about basic imaging features see section 5 Using Cornerstone Imaging in the Cornerstone User s Manual Section 1 Diagnostic Imaging Chapters 2 8 contain information of interest to all users of the Cornerstone diagnostic imaging features whether or not you use an IDEXX Digital Imaging system Section 2 IDEXX Digital Imaging Systems Chapters 9 21 contain information of interest to users of IDEXX I Visio
209. il providers have this requirement 7 Inthe SMTP User Name and SMTP Password text boxes type the information that Cornerstone software needs to log in to your email server 8 Inthe Email Attachment File Type drop down menu select the type of file to use for sending images This default can be changed at the time images are sent 9 Inthe Default Send Email Address text box type the address to be listed as the sender 10 In the Reply Email Address text box type the address to which the recipient should reply 11 Click Save to save and close the System Settings window or click Apply to save without closing the window 8 5 Setting Up Export Defaults The settings in the Export section of the Imaging Configuration window control the default type of image file that is sent when you export a case to a CD or DVD but you can change the file type when you export the case To set up export 1 Onthe Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Export 3 Inthe Export File Type text box select the file type that you want to use for exporting images 4 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 6 Setting Up Global Settings The settings in the Global Settings section of the Imaging Configuration window control several features which appear in more than one part of DICOM Imaging 100 Chapter 8 Setting
210. ile power is on or power is flowing CAUTION i The detector panel needs to warm up for 30 minutes prior to use CAUTION Prep and expose sequence IDEXX DR Relay Box See Chapter 21 The IDEXX DR Relay Box for information about the relay box In particular see 21 3 Using the IDEXX DR Relay Box for details about the prep and fire sequence 20 4 Inspections 20 4 1 Safety Inspections To avoid malfunctions and to ensure personnel patient and device safety IDEXX recommends annual inspections of the device These inspections are part of the preventive maintenance tasks within the scope of IDEXX Laboratories Inc service contracts Inspections include e Visual inspection for completeness and noticeable damage and defects as well as for contamination parts sticking together and wear that reduces safety e Inspection of the necessary monitoring safety display and annunciation devices e Measurement of the safety relevant output parameters e Further special technical inspections for the system corresponding to the generally recognized state of the art e Further necessary inspections according to manufacturer s details Note Maintenance and inspections must be performed only by trained specialists 20 4 2 Daily Operator Inspections Each day the operator needs to perform the detector plate self test described in the following procedure as well as check the device for obvious defects including e Damaged parts in
211. ils from a particular account for the staff member who is logged in If you set up a particular email account to be used for a staff member that account will be used for emails sent from the Image Explorer Image Viewer or the Email tab of the Case Actions pane on the Case Detail dialog box when that staff member is logged in to Cornerstone If you do not set up an email account for a staff member imaging emails will use the account that has been set up at the system level Note High speed Internet access is highly recommended because you will be transmitting large amounts of data when you send images To set up Digital Imaging email 1 2 On the Controls menu select Controls gt Defaults gt Imaging On the left side of the Imaging Configuration window select Email Email configuration options appear on the right Do one of the following a lo set up email options that will be used only with this user login click the tab with that user name 99 Chapter 8 Setting Up Basic Imaging Features b To set up email options that will be used by all users who do not have customized email options click the System tab with that staff member s name In the SMTP Server Name text box type the name of your email server In the SMTP Port text box type the number of the port to be used for sending email Check the Enable SSL check box if your email provider requires the use of SSL Secure Socket Layer ports Many internet based ema
212. image processing specify new level and strength settings for this image and click OK 5 Click OK Reprocessing begins 13 2 Using Window Level Presets You can set up presets to quickly apply new window and level settings to an image in the Image Viewer For more information on creating and editing presets see 8 10 Setting Up Window Level Presets 13 2 1 Applying a Window Level Preset When you apply a window level preset to an image in the Image Viewer the window and level values for that image change to the preset values To Apply a Window Level Preset gt Click the Window Level Presets tool os and select the preset that you want to use The window and level values for the image are changed 144 Chapter 13 Enhancing and Converting Images 13 2 3 Creating a New Preset from the Image Viewer In the Image Viewer you can create a new window level preset based on the window level values that are currently applied to the image that you are viewing To Create a New Preset paun 1 Click the Window Level Presets tool and select New from the bottom of the drop down menu The Presets Detail Configuration dialog box appears On the Name text box replace the placeholder text with a name that is more meaningful If you want to change window and level values by specifying exact values select Absolute in the Type text box Enter the window contrast value in the Window text box and the Level brightness value in the Lev
213. images you have the instructions for the newer scanner software below taken Capture for more information on e If you have not updated your Cornerstone software to version 8 3 or higher or are using the Windows XP operating system the image capture work flow has not changed Follow the instructions for the default scanner software below 124 To capture images with default scanner software 1 In the shot tree area on the right of the Image Capture window the first exam type in the list is automatically highlighted e To take this image continue with step 2 e To take a different image click the exam type for that image to highlight it IMPORTANT For best image quality the body part that you are imaging must match the exam type that is highlighted The exam type that is selected in the shot tree determines image processing values and the image orientation Use the technique chart that was provided by your installer to select suitable settings on your x ray equipment for exposure time and kVp Position the animal on the table and take the x ray Click Capture Image The Scanner Interface window appears Click the button for the body part then select the projection from the drop down list Note The body part and projection selected on the Scanner Interface window must match the exam type selected on the Image Capture window Click Upper Extremities for foreleg projections or Lower Extremities for hind leg projectio
214. in the Cornerstone software such as sending images via DICOM Before you use this feature set up the Web address es to which you want to connect see 8 11 Setting Up Remote Consult and IDEXX Integration Technology for Telemedicine To connect to a radiologist or telemedicine service Web page 1 From the toolbar at the top of the screen select Activities gt Imaging gt Remote Consult Request The remote consult providers that you have set up appear in the next level of the menu 2 select a radiologist or telemedicine service The consulting radiology Web page appears in a new window 40 Chapter 5 Reviewing Images 5 1 The Image Viewer Toolbar The Image Viewer window provides tools that let you change and enhance your images These tools are described below some image editing tools such as the Magnify tool and the Pan tool remain active until you do one of the following e Click the button a second time e Click another tool button e Right click anywhere on the image and select Complete Action from the pop up menu some of the tools are not displayed automatically To change the tools available in the Image Viewer see 5 4 Configuring the Toolbar Note Each image can have only one manipulated version If you make changes to the manipulated version the IDEXX Cornerstone Practice Management System will overwrite your previous manipulated image The original image is never overwritten You can always return t
215. ing the IDEXX I Vision Mobile Application 23 4 5 Request Screen Use this screen to create image requests These requests bat AN im appear in the Open Request area of the Imaging Dashboard ag screen in the Cornerstone software Select a request and click Capture Images and the image capture process begins with the views already selected in the shot tree To request radiographs b 1 Tap a dot te to see the top level menu I 4 Figure 23 4 The Request screen Tap b to open a group in the menu Tap view s to select 4 Double tap a group name to select the whole group Shots Requested shows views you ve selected Shoals requessied Thorax L Lat 5 Thera A Lat x 5 Tap amp to remove a view or Remove an to clear the whole list 6 Tap Submit to submit request Requests you create on a tablet will be visible in the same places as other SmartLink Digital Imaging requests you create For more information about using IDEXX SmartLink Digital Imaging with Cornerstone see Chapter 22 Using IDEXX SmartLink Digital Imaging and Modality Worklist Integration 268 Glossary Annotation Annotations are explanatory notes or shapes that a user can add to an image using the tools found in the Annotation drop down toolbar on the Image Viewer window Archiving Archiving is the process of moving images to another location such as a CD or a portable hard disk Generally archiving is done to mak
216. ious components of the IDEXX I Vision CR system scanner before operating it Scanner status indicator Indicates the status of the scanner Cassette tray Guides the cassette into the scanner for scanning and erasing of imaging screens Cassette position indicators When cassettes of different sizes are inserted into the scanner their edges should line up with the corresponding indicator marks on Scanner status indicator Cassette position indicators Cassette tray Figure 18 1 Front view of scanner On off switch Turns the scanner on off Power connector lIs where the AC power cable plugs into the scanner USB connector Connects the scanner to the computer via a USB cable On off switch Power connector o M a USB connector Figure 18 2 Rear view of scanner 181 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 2 1 Before Using the Scanner Before using the IDEXX I Vision CR system scanner each day check to ensure that e The USB cable is connected between the computer and the scanner e The scanner is plugged into the power source e The scanner power switch is turned on e The computer and monitor power switches are turned on e The scanner status LEDs are green Also we recommend that you erase any imaging screens that have not been used in several days see 18 3 3 Erasing Imaging Screens for more information 18 2 2 Scanner Status Indicator The scanner status ind
217. ip Magnify Da Invert Restore Original 6 The tool s action is applied to all of the selected radiographs fl Chapter 6 Distributing Images and Using DICOM 6 1 About the DICOM Standard The DICOM Digital Imaging and Communications in Medicine standard allows for the transfer storage and printing of digital images between software and equipment regardless of the manufacturer The DICOM standard is both an image file format and a communication protocol that allows for the exchange of medical images between devices such as a computer workstation and a printer or between two networks The DICOM image file format standard defines the data set that must be stored for an image in one file data dictionary requirements for the image type options for the image type The DICOM communication protocol based on conformance statements defined for each individual DICOM device defines how information is shared between devices such as computer workstations printers and readers The IDEXX Cornerstone Practice Management System allows you to print digital images to a DICOM printer Cornerstone also supports the ability to save and read DICOM files 6 2 Printing Images to a DICOM Printer To print images to a DICOM printer 1 On the Patient Clipboard in the Patient History area right click the image series and select Image Explorer pm Select the images you want to print and click DICOM Print Do the following
218. is case In the Staff User drop down list select the staff member or Cornerstone software user associated with this case In the Case Categories list select a category that you want to assign to this case If you want to select more than one category hold down the CTRL key while you select the categories you want Note You can use case categories when using the Advanced Search tab on the Image Explorer Window If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter To create a case from the Patient Clipboard 1 On the Patient Clipboard in the Patient History area right click and select New Case The Case dialog box appears In the Case Title text box type a name for this case In the Staff User drop down list select the staff member or Cornerstone software user associated with this case In the Case Categories list select a category that you want to assign to this case If you want to select more than one category hold down the CTRL key while you select the categories you want Note You can use case categories when using the Advanced Search tab on the Image Explorer Window If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter 26 Chapter 4 Cases and Telemedicine 4 3 Adding and Removing Case Images and Docu
219. is shown above the series that belong to that study If you are using an IDEXX Digital Imaging system you can also see studies in the Most Recent Studies list on the Imaging Dashboard window The DICOM standard requires series and study information be recorded for every image If you take only a single image during a capture session a series and study will still be created even though that image is the only image in the series and that series is the only one in the study Note Because the terms series and study are part of the DICOM standard you may encounter them when using other DICOM compliant equipment such as endoscopes or ultrasound machines 19 Chapter 2 Program Basics 2 3 4 How Images Series and Studies Are Named If you import images from DICOM compliant devices such as endoscopes or ultrasound machines Cornerstone imports the series and study information created by those devices If you import images from a non DICOM source Cornerstone names the study for today s date and asks you to give the series a title 2 4 Common Interactions Cornerstone DICOM Imaging has been designed so that a number of different windows function in similar ways Below are some tips to remember when using diagnostic imaging features To select multiple items gt Ifyou want to select more than one image thumbnail on the Image Explorer window or the Image Viewer window or for IDEXX Digital Imaging system users if you want to
220. isplay Completed items for only the last 31 days Partial items are image requests where some of the radiographs have been completed and some have not Not Requested items are additional radiographs that have been taken but are not part of an image request 251 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration e lf you want to narrow the list of image requests displayed to only view requests assigned to a particular staff member select the staff from the Staff drop down list in the Other area default is All Staff For IDEXX SmartLink Digital Imaging only f you want to verify the image shots that have been selected for a request click the request s Shot Selection icon to open the Shot Selection dialog box in view only mode Any image shots previously assigned to the request will be selected in the shot tree To change the shots selected for this request you must update the request Note The Shot Selection icon displays as a shot tree with a sign i if shots have not been added for the item and as a standard shot tree amp no sign if shots have already been selected for this invoice item Use the buttons on the Image Requests and Results window to perform any of the following tasks Note The New Update and Delete button tasks can also be selected by right clicking an image request line and selecting the task from the pop up menu e To create a new image request click
221. ital Imaging Systems It restores an earlier version of the image but with one key difference Reprocessing displays the original version that was captured but with new level and strength edge enhancement settings that you select See 12 3 Advanced Image Enhancement Reprocessing 64 Chapter 5 Reviewing Images 5 13 Editing Image Details The Edit Image Details tool opens the Image Details dialog box which contains two tabs where you can view and update additional details about the image Note The image details feature should be used only in a manner a ed Fle en consistent with local laws governing the maintenance of veterinary Linker Jeoras ee am records used for diagnostic purposes sant pie en a i To enter or modify image details dae E ee 1 In the top section of the Image Details tab you can change the Meco i information in the following text boxes NO e Study displays the name of the image study to which this image belongs This name is automatically filled in when you capture an image If you change it here it is changed for all images in this study e Title is the name of this image When you capture an image the EL a Eha AA E Le Pm Larian Fis gjah ETTE TET E ETE TEs p ahii isy rregi exam type becomes the title of the image Figure 5 7 The Image Details tab on the Image Details dialog box Series Title displays the name of the image series to which this image belongs This name is automat
222. l Presets and then select Original As Initially Displayed from the drop down menu 145 Chapter 13 Enhancing and Converting Images The Reprocess tool restores an earlier version of the image but with one key difference Reprocessing displays the original version that was captured but with new level and strength edge enhancement settings that you select For more information about reprocessing see 12 3 Advanced Image Enhancement Reprocessing 13 4 Converting Images Captured in Older Versions of Cornerstone Version 8 0 of the IDEXX Cornerstone Practice Management System saves images in a different file format than some older versions of Cornerstone version 7 1 and earlier Images that have not yet been converted to the new file format have thumbnails that show a question mark When you convert an image to the new file format the thumbnail becomes a small version of the image just like the thumbnails for newly captured images Note You are most likely to see the question mark icon if you are using the IDEXX CR 1417 Digital Imaging System In older versions of Cornerstone a thumbnail image was created for only one of the four images in each series of four radiograph views while in version 7 5 and higher a thumbnail is created for every image that is captured To convert an older image to the new file format 1 On the Patient Clipboard in the Patient History area double click the image series The Image Viewer window a
223. l Radiography In the Template drop down list select the template you want to use when you display a new series of dental radiographs in the Image Viewer for the first time Click Save to save and close the System Settings window or click Apply to save without closing the window Click an image or hold down oy and click more than one image lt x Click Review Dental Images then select Review Selected Image s The image or images appear in Review Selected Images mode which displays the image s in a larger size Figure 5 10 Review Selected Images mode 70 Chapter 5 Reviewing Images To view one or more radiographs in Review All Images mode 1 Click an image or hold down CTRL and click more than one image 2 Click Review Dental Images then select Review All Images amp The images appear in Review All Images mode which displays a grid of all the images that appeared in the template To return to Template mode gt Click Back to Series in the upper right corner of the Image Viewer 5 15 3 Enhancing Radiographs in Any Mode To enhance a radiograph Figure 5 11 Review All Images mode gt Click the image to highlight it and then click one of the tools shown in red PEIES To enhance multiple radiographs at once pu 1 Hold down CTRL and click to select the radiographs a 2 Click any of the following Figure 5 12 The Back to Series button Print ima EN Rotate and Fl
224. l part of the EquiView system Keep it close to the system for ready reference Observance of the instructions contained in the operator s guide is a precondition for the use of the system for the intended purpose and for its correct operation The system may be operated only by personnel who have the necessary knowledge and have been instructed in its use Operator safety and trouble free operation of the system are only ensured if use is made of original equipment parts Moreover only those accessories may be used that are specified herein or that have been expressly approved and released by IDEXX IDEXX cannot guarantee the safety or proper functioning of this system if parts or accessories are used that are not supplied by IDEXX The safety features of the EquiView system are only ensured if the following points are adhered to e You should not use the system if it has any electrical or mechanical defects This applies in particular to display warning and alarm equipment e If you want to connect the device to other devices components or assemblies other than those described in this chapter of the Cornerstone Digital Imaging User s Guide and if a hazard free combination with these devices components or assemblies cannot be deduced from the technical data you must consult the respective manufacturer to ensure that the safety of the patient the operating personnel and the environment are not affected by this intended combination 211
225. late In the Save Template Mapping dialog box type a name for this new template layout The Image Viewer remembers the DICOM designations of the radiographs in each cell Whenever you view radiographs in this template layout the Image Viewer assigns radiographs to cells according to the same designations If you want this new template layout to be used when a new dental series is displayed in the Image Viewer for the first time select Make this my default template Note You can customize where particular radiographs go in the template but you cannot rearrange the position of the template cells themselves 69 Chapter 5 Reviewing Images To display radiographs in a different template layout L ee 3 Click Templates Gia To display representations of the layouts move the mouse over the choices in the drop down list select one of the template layouts The radiographs are displayed in that layout To set the default template 1 5 15 2 Review Selected Images Mode and Review All Images Mode To view one or more radiographs in Review Selected Images mode 1 2 Do one of the following FR e On the Image Viewer window click Display Configuration and select Edit Modality ae Defaults E3 e On the Imaging Dashboard or Image Explorer windows select Tools gt Settings gt System in the menu bar then select Modality Layout on the left side of the System Settings window In the Modality drop down list select Intra ora
226. le creates a service item for a pair of common radiographs at each different weight setting An example based on IDEXX CR or I Vision CR systems would set up items based on species The invoice items for the different weights are set up with different prices and a Group item smart code is used to make the whole arrangement easy to work with With this advanced example shots are preselected on the Shot Selection dialog box when setting up the Image Request special action How it works primary work flow 1 Adda Group item containing your imaging item to the PVL or invoice for a patient The New Image Request dialog box appears 2 Verify the image request details i e staff amount etc and make changes if necessary When you click OK on the New Image Request dialog box the charge is automatically recorded on the PVL as part of the Group item 3 When ready to begin the image capture process select this request on the Image Requests and Results window and click Capture Images The applicable weight specific shots are already selected for you How to set it up The following example creates a Group item called Radiograph Thorax 2 View that assigns the appropriate thorax shots based on the weight of the patient Note This example is set up for use on an IDEXX DR system The setup steps would be slightly different for an IDEXX CR or I Vision CR system where shots would be assigned based on species 243 Chapter 22 Using
227. lement are integral parts of the IDEXX l Vision DR System Keep them close to the system for ready reference Observance of the instructions contained in these documents is a precondition for the use of the system for the intended purpose and for its correct operation The system may be operated only by personnel who have the necessary knowledge and have been instructed in its use Operator safety and trouble free operation of the system are only ensured if use is made of original equipment parts Moreover only those accessories that are specified herein or that have been expressly approved and released by IDEXX may be used IDEXX cannot guarantee the safety or proper functioning of this system if parts or accessories are used that are not supplied by IDEXX The safety features of the IDEXX I Vision DR System are only ensured if the following points are adhered to e You should not use the system if it has any electrical or mechanical defects This applies in particular to display warning and alarm equipment e If you want to connect the device to other devices components or assemblies other than those described in this supplement and if a hazard free combination with these devices components or assemblies cannot be deduced from the technical data you must consult the respective manufacturer to ensure that the safety of the patient the operating personnel and the environment are not affected by this intended combination 222 Chapter
228. lets you map IDEXX specific fields in the local DICOM server to a manufacturer s DICOM fields The IDEXX DICOM Services program contains a list of predefined manufacturers and their specific modalities e g computed radiography computed tomography magnetic resonance You can select a specific manufacturer modality from the lists and then map your local DICOM server s fields accordingly New manufacturers modalities are added when the new device pings the local DICOM server and a connection is made The new device sends a DICOM file to the local server this file contains the names of the manufacturer and the modality The IDEXX DICOM Services program stores that information and makes it available in the Manufacturer Mapping window You can then map your local DICOM server s fields as needed to ensure successful communication between the two devices To add a manufacturer 1 On the Controls menu select Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select DICOM Services and then select Manufacturers 3 Click Add to add a row to the Manufacturer table Type the manufacturer s name in the new row Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window To map a device s fields to the local DICOM server fields 1 Onthe Controls menu select Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select DICOM Services and th
229. lick Details to view data about the failure Click OK to return to the Remote Servers defaults in the Imaging Configuration window To delete an external server configuration 1 2 On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration dialog box select DICOM Services and then select Remote Servers In the Remote Servers table select the server you want to delete Click Delete Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 3 4 Defining the Manufacturer Mapping Each DICOM device local or external has its own DICOM conformance statement One component of this statement defines the device s fields which each consist of a group number and an element number Most manufacturers use a universally defined DICOM standard group number and element number for each common text box e g patient name patient ID study date referring doctor name Occasionally however a manufacturer may assign a different group number and element number to 97 Chapter 8 Setting Up Basic Imaging Features one of these common fields Each text box whether common or device specific has a group number and element number and is defined in the device s conformance statement To ensure successful communication between devices the fields from one device must be mapped appropriately to the fields of another device The Manufacturer Mapping window
230. ling is active the temperature control module will keep heating or cooling until a temperature of 77 F 25 C is reached in the case 207 Chapter 19 The IDEXX EquiView Digital Imaging System 19 7 2 Protective Sleeve Digital x ray plate A plastic protective sleeve is provided with your x ray plate During use keep the x ray plate in the protective sleeve to help protect it from dirt water and scratches 19 7 3 Tunnels Tunnels are specialized items for holding the plates under a horse s foot and positioning the foot Using the tunnel you can place the digital x ray plate under the hoof and position the foot in a Suitable manner 19 8 Technical Specifications Type of device Device for digital x ray exposure picture manipulation and archive system 19 8 1 Dimensions Computer dimensions laptop in case Height 45 7 cm 18 Depth 21 cm 8 25 Width 55 9 cm 22 Figure 19 5 Tunnel for positioning the digital x ray plate under the hoot Figure 19 4 Transport and storage case with temperature control for digital x ray plate Location Mobile portable unit Computer dimensions rugged box Height 36 cm 14 2 Depth 26 cm 10 2 Width 41 5 cm 16 3 Weight 14 9 kg 32 9 Ib Location Mobile portable unit 36 cm 14 2 21 cm 8 25 Laptop version CPU 2 0 GHz 45 7 cm 18 Memory SDRAM 2 GB Integrated Graphics Media accelerator 41 5cm 16 3 Figure 19 6
231. list displays invoice items that match 254 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration d Select the invoice item you want and click Select e Select the appropriate revenue center if it does not appear automatically To see a list click the Revenue Center text box and press F2 When you are finished click OK to close the Not Requested Image for dialog box and then click Close to close the Image Requests and Results window The image is now listed as Completed in the Patient History area on the Patient Clipboard To reassign a Not Requested image that is assigned to the wrong patient 1 2 S oo eS e On the Image Requests and Results window select Do not bill this client and click OK to exit On the Patient Clipboard right click the image in the Patient History area and select Image Explorer On the Image Explorer window select the image and click Reassign Reassign the image to the proper patient Close the Image Explorer View the proper patient on the Patient Clipboard Right click the image in the Patient History area and select Image Requests and Results On the Image Requests and Results window the image has a status of Not requested Follow the procedure above to bill or not bill for the Not requested image 22 5 8 Manually Setting Requests to a Status of Completed If the imaging system does not support MPPS Cornerstone will not receive information about the
232. ll also show more noise in the other parts of the image 141 Chapter 12 Checking and Approving Images To reprocess an image with standard image processing 1 Click Reprocess The Reprocess dialog box appears Type new values for Level and Strength in the text boxes Click Apply The image is restored to its original appearance but with the new edge enhancement settings applied IMPORTANT The Reprocess feature returns the image to its original state This means that changes you made to the image such as cropping or adjusting the window level are undone Annotations are also removed from the image 12 3 3 When to Reprocess an Image You might want to use reprocess when an image was captured using an exam type that did not match the body part that was x rayed For instance if an image was taken for a skull exam type but the animal s abdomen was actually x rayed Cornerstone applied the level and strength values that work best for skull images These values would not be the best for the abdomen similarly reprocess may be useful if you take an image of an animal that has a metal implant In this case edges next to the implant appear darker or hazier than they would be normally To get a better view of the area around the implant try reprocessing with a level value of 3 and a strength value of 40 If the edge enhancement still needs to be fine tuned try reprocessing again and lowering one or both values 12 4 Saving Images T
233. log box appears so that you can select a patient and begin the image capture process To view images Do one of the following Click View Images without selecting anything from the lists The Image Explorer window appears so that you can search for a patient s images Select a client in the Recent Clients list or a patient in the Recent Patients list and then click View Images The Image Explorer window opens and displays the images for this client or patient Double click a client name in the Recent Clients list or a patient name in the Recent Patients list The Image Explorer window opens and displays the images for this client or patient Select a study in the Recent Studies list then click View Images The Image Viewer appears One image is displayed in the viewer window and the other images from that study are displayed in the thumbnail area Double click a study in the Recent Studies list The Image Viewer appears One image is displayed in the viewer window and the other images from that study are displayed in the thumbnail area Some additional functions are located at the top of the Dashboard window In the Imaging Quick Search text box type a patient s name a client s first or last name or a client ID or patient ID When you click Search Cornerstone displays the results of your search in the Image Explorer window Click Advanced Search to display the Image Explorer window where you can search for images and then vie
234. ly onto the panel Instead moisten a AN cloth with the solution and wipe the panel CAUTION E f Do not immerse the panel in liquid Do not autoclave the panel CAUTION 15 9 8 Electrical Safety Information DO NOT OPERATE THE IDEXX DR 1417 SYSTEM UNDER THE FOLLOWING CONDITIONS iii Do not operate the system in potentially explosive atmospheres e Do not operate the system in the presence of potentially explosive gas mixtures such as those that can form when cleaning agents disinfectants flammable anesthetic material skin cleaners oxygen and some coupling agents are used even when used on the patients 15 9 9 Power Cord Safety Information When operating the digital x ray detector a certified detachable power supply cord AN must be used and comply with the following criteria CAUTION To meet applicable U S regulatory agency requirements use the power cord supplied with the IDEXX DR 1417 system which meets the following criteria Cord e Type SJT e Minimum No 18 AWG wire e 3 conductor wire e Rated minimum 10 Amps 125V e Maximum length of 13 ft 4 m 161 Chapter 15 The IDEXX DR 1417 Digital Imaging System Plug e Molded on grounding type attachment plug e Listed Hospital Grade e Either 120V NEMA 5 15P or 240V NEMA 6 15 type 15 9 10 Mechanical Safety Information Ensure that the patient is suitably restrained in accordance with accepted standards for administration of treatment 15 10 Cauti
235. m as described in section 21 2 above be sure to wait until the generator has stopped spinning although the system may allow you to prep before the generator is ready no radiograph will be captured 21 4 Troubleshooting The IDEXX DR Relay Box can be a helpful source of troubleshooting information while you are on the phone with IDEXX Digital Imaging Support In some situations however there are also a couple of basic troubleshooting procedures that you can perform before calling If you follow the instructions below and the problem persists call IDEXX Digital Imaging Support at 1 877 483 9948 If none of the LEDs on the front of the relay box are illuminated This can indicate that the relay box is not working Do the following 1 Check that all of the connections on the back of the box are secure 2 Check that the DR Controller Box is switched on The green LED should be illuminated If you see flashing red and green LEDs when starting the system This can occur if the foot or hand switch is pressed down when the system is started Do the following 1 Release the foot or hand switch Normal operation should resume 2 Continue using the system as usual You do not need to restart the system To test that the relay box is properly connected If you don t see the correct response from the system at any point in the testing process below call IDEXX Customer support at 1 877 433 9948 WARNING In step 3 of this testing proc
236. m scanner 17 3 Scanner Status LEDs Certification and Identification Label Two light emitting diodes LEDs are located on the front of the IDEXX CR 1417 system scanner above the cassette entry slot To indicate scanner status each LED can appear green or orange the color can be either steady or blinking In general e Steady LEDs indicate the system Is ready for you to make an action e Blinking LEDs indicate you should wait an operation is in progress e Green LEDs indicate the scanner is working properly e Orange LEDs indicate a problem Table 17 1 LED configurations displayed during scanner operation System Status Left LED Right LED System LED Process LED Rotation motor calibration Green Blinking Green Blinking Se eT NDI AP Green Blinking Green Blinking please wait Insert cassette Green Steady Green Steady Loading cassette screen Green Blinking Green Blinking Ready for scan Green Steady Green Steady scanning Green Blinking Green Blinking 171 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System saving image and erasing Green Blinking Green Blinking Unloading cassette screen Green Blinking Green Blinking Error Orange Blinking Orange Blinking 17 4 IDEXX CR 1417 Imaging Cassettes and Screens The imaging screen for the IDEXX CR 1417 system scanner is contained within a cassette and should remain there for normal use During normal use the only time a screen is out of the cassette is when the scanne
237. mage or injuries Safety circuits may neither be removed nor modified safety cannot be ensured if users open the casing of any hardware component of the IDEXX DR 1417 system or remove parts from any component 15 9 2 Applicable Standard The digital x ray plate and associated cables have all been tested for compliance with the safety standards in effect at the time of manufacture in the United States UL 60601 1 Canada C22 2 No 601 1 and the European Union EN60601 1 This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions may cause harmful interference to other devices in the vicinity However there is no guarantee that interference will not occur in a particular installation If this equipment does cause harmful interference to other devices which can be determined by turning the equipment off and on the user is encouraged to try to correct the interference by one or more of the following measures Reorient or relocate the receiving device Increase the separation between the equipment 157 Chapter 15 The IDEXX DR 1417 Digital Imaging System Connect the equipment into an outlet on a circuit different from that to which the other device s are connected Contact IDEXX Digital Imaging Support For service within the United States or Canada call 1 877 433 9948 Classification i 2 3 Class equipment Ordinary equipment Equipme
238. mage Viewer window with the Cine toolbar displayed along the bottom of the window Use these tools to view the selected cine file a a Click Play Pause to start pause or resume the video gO Click Stop to stop the video and return to the beginning Click Slower to slow down the video Click Faster to speed up the video E in Fesa Cleat Him Lep Patent Fasean m a n ANAIA Chapter 5 Reviewing Images Gime Figure 5 6 Viewing a cine file in the Image Viewer Har Veirai Pate Liner ant FEL 61 Chapter 5 Reviewing Images Click Capture to capture a single frame of the video as a still image The still images you capture from the video can be enhanced and edited using the editing and annotation tools and they are saved as part of the same series as the original video Note The Cine toolbar appears only on the original video image Click Zoom In to increase the size of the image Click Zoom Out to decrease the size of the image Click Full Screen to make the video fill the screen Note Use the following keys to control playback in full screen mode e Press the SPACEBAR to play or pause the video e Press ESC or double click anywhere on the screen to return to the Image Viewer in normal mode Click the slide bar to move quickly to a specific spot in the video 5 11 Using Window Level Presets This tool is available only in the IDEXX PACS software formerly th
239. maging screen is then ejected into the cassette the cassette unlocks from the scanner and can be removed and reused In the event that the screen and cassette do not eject turn off the scanner and then turn it back on This ejects the screen and cassette If this does not work unlock the cassette manually by pulling the screw beneath the cassette tray 17 4 4 Erasing Imaging Screens After each image is scanned from a cassette the screen is automatically erased so that it is ready to accept the next x ray image Although the imaging screen is encased in a protective cassette over time the unused screen absorbs radiation that exists naturally in the surrounding atmosphere You should use the scanner to erase the screen manually if e The cassette has not been used in several days e A scan was stopped while only partially completed by clicking Abort from the scanner interface window 173 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System To erase the imaging screen ily A 3 C N o Be sure that the scanner is turned on and that the System LED is green Insert the cassette into the scanner See 17 4 2 Loading a Cassette for more information On either the Imaging Dashboard window or the Image Explorer window click Capture Images as if you were beginning the image capture process The Select Client and Patient dialog box appears Type the name or ID of any client or patient in the Search box and
240. may be off by a fraction of a millimeter When absolute accuracy is required include a reference object of a known size in your image Also the Actual Size feature does not work if you are using your computer with a projector that displays the image at a very large size e g on a wall Magnify Tools Clicking the Magnify Toolbar tool opens up a set of tools that you can use to enlarge a portion of the image cy The Magnify tool allows you to see a particular part of an image in greater detail Click the tool and then click any area of the image to view that area in greater detail As you move the tool around the image you move the area that is magnified When you stop moving the magnify tool a scale appears at the bottom of the magnified area Move the slider on the scale to increase or decrease the amount of magnification from 1x to 10x You can also change the window and level contrast and brightness within the magnified area by selecting the Lock Window check box and then clicking and dragging the mouse pointer within the magnified area When you are done deselect Lock Window to continue using the Magnify Tool or click the Magnify button again to deactivate the magnifier 46 ae gG The Customize tool allows you to change the way the Magnify tool works Click the Customize tool to open the Advanced Magnification dialog box Specify the desired height and width of the Magnify tool area in pixels In the Zoom text b
241. mbnail Right click the thumbnail and select Email from the menu Do the following e Select Image to create a case with only the images you have selected e Select Series to create a case with the series to which the selected images belong e Select Study to create a case with the study to which the selected images belong e Select Apply Overlays if you want the images to contain the overlay information displayed in the Image Viewer 80 Chapter 6 Distributing Images and Using DICOM e Select Apply Annotations if you want the images to contain the annotations created in the Image Viewer Click Select The Email dialog box appears In the To text box select or type the email address or leave the default value Note You can also click Address Book select an email address and click OK to load that email address in the To text box See 6 5 1 Using the Address Book In the Subject text box type the subject of the email or leave the default value your practice name To include a message type it in the Message text box select the image file format in the Export File Type drop down list The text boxes in the lower left corner of the dialog box display the number of images and the estimated total size of the images in megabytes MB Click Send to complete the process 6 5 1 Using the Address Book The address book gives you quick access to email addresses to which you frequently send images from Cornerstone To s
242. ments You can add images to a case that are stored within the Cornerstone software and you can add images or documents to the case from outside the software After you have submitted a case to a telemedicine provider however you need to use the telemedicine provider s Web site to submit additional images or documents 4 3 1 Adding and Removing Images Stored in Cornerstone To add Cornerstone images to a case from the Case Detail window 1 via On the Case Detail window if the Thumbnails pane is not open click the Thumbnails header If you want to attach supporting material do the following a Click Attach File The Open dialog box appears b Use the dialog box to select the file s you want to add and click Open c Repeat these steps if you want to attach additional files If you want to attach additional images do the following a Click Add Image A small version of the Image Explorer window appears displaying thumbnail images for this patient b Click the image you wish to add or hold down the CTRL key and select multiple images c Click Select Image The images are added to the case If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter To add Cornerstone images to a case from the Image Explorer 1 2 3 Select one or more images series or studies on the Image Explorer window Click Add to Case or right
243. mport Images from Remote Servers ccc cece ceeeeeeeeeeeeees 23 3 3 Using the DICOM Drop Folder to Import Images Automatically 00 0 ccecceceeeeeeeeeeeeeeeseeeeeeeaeenees 23 Chapter 4 Cases and Tel MediICING ccccesscsesseeeseeeseeeeeeeeseeeneeeeseeeneeeaeeoeseneaeeonseoaeeaeeoeaeeoas 24 4 1 About the Case Detail WV NAC OW sscscieceesceicn toe ion tnnndu ete cpunst tee Gesecdet etchant edecnbaea dave ld ba dn sdtealha caine diane sucntoedsewies 24 42 EAMG CASS saicopens tetas eees irira ara niri AE EEEE EEEE KEARE AN A N A AEA r aS RaR R SEREA IAEE EAEAN Zo 4 3 Adding and Removing Case Images And DOCUMENTS cc ccccccccscccccscceeeeeesssssseseesesesesesseeeseeeeeeeeeeeees 27 4 3 1 Adding and Removing Images Stored in Cornerstone ccc i iii ri lillie 27 4 3 2 Adding and Removing Outside Images and Other Attachments ccccccccccccceceeeeeeeeeessenenees 29 4 3 3 Adding Images and Other Attachments after Submitting a CASE ccc c cece ccccceceeeeeeeeeeeeeenees 29 At YIN AIIM NE O cosas ence sre an tna agar edeteiger sates Gang tant ys ae as as E E EEE EREA 30 4 5 CASS SEMIN FC UIOING iti stntit dha Sinsistin haSithe Sines st teeth at hea Ra aa aa aa aaa Ea E a eaaa 31 45 1 Creaing a Piel CDO IW es NS Ce ate onc oars cscee ce naanneeteaeaeae seatanseauatnouttsina sin ameasaieesecncuuescuauntananen 32 452 Eman GAGS eeren aie eia ie DNE ENRERE RRE ERE nits R R E A e a Ta a aa EEEN 34 FUG MUO Ml E A eta gt aa as asta
244. n Cornerstone The marker will be flipped and rotated whenever you flip or rotate the whole image To add a position marker to an image 1 Inthe Capture window after you have captured an image click Marker UR The drop down menu appears 2 Select a marker type L for either lateral or left M for medial R for right 3 An X appears in all four corners of the image Click the X in the corner where you want the marker to display Note You can change the marker by clicking the tool again and repeating these steps Once you leave the capture window however the marker is fixed You cannot move the marker to a different location or remove it from the image 135 Chapter 11 Image Coach and Other Tools 11 6 Using ClearCapture Dx Image Processing Software ClearCapture Dx Image Processing Software offers advanced image processing to users of IDEXX I Vision DR IDEXX DR 1417 and IDEXX CR 1417 systems The process of capturing radiographs is slightly different if you are using ClearCapture Dx software If you are using an IDEXX I Vision DR or IDEXX DR 1417 system with ClearCapture Dx software the reprocess feature works slightly differently than it does with standard image processing For more information see 12 3 Advanced Image Enhancement Reprocessing If you are using an IDEXX CR 1417 system with ClearCapture Dx software you capture a single radiograph each time you scan a cassette rather than capturing a series of
245. n CR IDEXX CR 1417 IDEXX I Vision DR IDEXX DR 1417 and IDEXX EquiView systems Some of these chapters like Chapter 13 Enhancing and Converting Images add to the information found in similar chapters from section 1 Others like Chapter 10 Capturing Images are unique to section 2 Chapters 15 21 cover technical and safety information Note IDEXX Digital Imaging systems have been tested for use with dogs cats horses mice rats guinea pigs and rabbits These systems are intended for veterinary use only they are not intended for human diagnostic use Section 3 Imaging Integration Chapter 22 contains information about using IDEXX SmartLink Digital Imaging to integrate Cornerstone with an IDEXX Digital Imaging system It also contains information about using the modality worklist feature of the DICOM standard to integrate Cornerstone with third party imaging devices such as ultrasound and dental radiography Section 4 IDEXX I Vision Mobile Application Chapter 23 contains information about using the IDEXX I Vision Mobile Application with iPad or Android tablets 1 2 Overview of Imaging in Cornerstone There are three levels of imaging features available in the Cornerstone Practice Management System e Cornerstone Imaging Cornerstone lets you import view and send basic types of images and attach them to the patient s medical record 10 Chapter 1 Introduction DICOM Imaging lf you ha
246. n the small black switch box turns from green to red and the green light on the white interface box is displayed You also hear the usual sounds that your x ray generator tube makes when preparing to fire 2 When the system is fired an image is taken the lights on both the black and white boxes flash blue This lets you know that the x ray generator has fired At this time the x ray generator makes its standard exposure notification 3 When the system is ready to fire again to take another image the light on the black switch box turns to green Prep and expose sequence IDEXX DR Relay Box Your system may be set up with the IDEXX DR Relay Box replacing the black and white boxes See Chapter 21 The IDEXX DR Relay Box for information about the relay box including details about the prep and fire sequence in 21 3 Using the IDEXX DR Relay Box 15 4 Inspections 15 4 1 Safety Inspections To avoid malfunctions and to ensure personnel patient and device safety IDEXX recommends annual inspections of the device These inspections are part of the preventive maintenance tasks within the scope of IDEXX Laboratories Inc service contracts Inspections include e Visual inspection for completeness and noticeable damage and defects as well as for contamination parts sticking together and wear that reduces safety e Inspection of the necessary monitoring safety display and annunciation devices Chapter 15 The IDEXX D
247. name as entered on the Configure DICOM Element dialog box 4 Type the width and height in pixels for this format Supported formats are given in the DICOM conformance statement for the selected printer 5 Click OK Note Be sure to click Save on the Select DICOM Printer dialog box when you have finished all configuration work for this printer 8 13 Setting Up Imaging Shortcuts For a list of the imaging shortcuts available on the Image Viewer see 5 8 Using Imaging Shortcuts Note If you are using an IDEXX Digital Imaging System you can also use these shortcuts on the Image Capture window To activate or deactivate the image enhancement shortcuts 1 Select Controls gt Defaults gt Staff 2 select the Miscellaneous tab 3 Select the Enable Imaging Shortcuts box to turn on the shortcuts Clear the box to turn off the shortcuts 4 Click Save to save and close the Staff Defaults window or click Apply to save without closing the window 8 14 Setting Up a Default Image Explorer Search Tab You set up the Cornerstone Imaging software so that the Advanced Search tab is displayed each time the Image Explorer window appears By default the Quick Search tab is displayed when you open the Image Explorer Note You can always move from one tab to the other no matter which tab is initially displayed To choose a default Image Explorer search tab 1 Select Controls gt Defaults gt Staff 2 Select the Miscellaneous tab 3 T
248. ned a line of communication or association is created between the two devices When that line of communication is ended the socket must be closed This text box defines how long it takes before the socket is closed specify the maximum protocol data PDU unit in the Maximum PDU Length text box This value can be found in your local DICOM server s conformance statement specify the number of seconds that can elapse before the local DICOM server times out in the Request Timeout text box This text box defines how many seconds can pass after the local server receives a request If a request is not fulfilled the local server times out For example if this value is 60 seconds and the local DICOM server receives a request to accept an image from a device the local server keeps a line of communication open between itself and that device for 60 seconds If no image is received within that time the local server times out and closes the line of communication The association between the two devices ends Select the Incoming DICOM Server Registration Required check box if you want Cornerstone to accept DICOM files only from servers that are on the remote servers list If this check box Is not selected DICOM files will be accepted from any remote server In the Watch Directory text box specify the directory from which DICOM services should automatically import images By default the watch directory is named dicomdrop and is located in the Cstone di
249. ng from the Image Explorer you can select an image and launch the Image Viewer in a special compare mode that lets you see the current version of the image next to the version of the image that was originally captured To compare an image to its original version 1 Inthe Image Explorer select an image Then either right click and select Compare to Original or click the Compare to Original button The Image Viewer is displayed with the current version of the image on the left and the original version of the image on the right 2 The Save Image dialog box appears when you close the Image Viewer Choose one of the following e Current to save the current image including any changes you made e Original to replace the current version of the image with the original version Any changes you made to the original image in the compare window are saved e Neither exit without saving to close the Image Viewer window without making any changes to the image 5 6 Cloning Images This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software When you clone an image you make a copy of the current version of the image 58 To clone an image 1 2 In the Image Viewer click the thumbnail of the desired image so that a red border appears Right click the thumbnail and select Clone from the menu The new
250. nking green Press the switch part way Fast blinking red prep the generator Fast blinking green Press the switch all the way expose and hold for the entire exposure Steady yellow Steady red Slow blinking green Hold down the Test button Steady green Relay box LEDs display Steady red for 30 seconds System state Generator is initializing Generator is on and idle Detector is prepping Detector has finished prepping and is ready to expose System is signaling the generator to expose and the detector to receive the exposure The DR control box is resetting 10 20 seconds Generator is on and idle Test mode is used for troubleshooting with the help of IDEXX Digital Imaging Support 1 877 433 9948 What you can do Wait You can begin the process of capturing a radiograph Wait Make final position adjustments and time the exposure for the animal s breathing IMPORTANT Don t wait more than 15 seconds before exposing Wait You can begin the process of capturing another radiograph 230 Chapter 21 The IDEXX DR Relay Box 21 3 1 Resetting If You Release the Switch Before Exposing If you release the foot or hand switch after you have prepped but before you have exposed you need to wait until the system is ready and then prep the system again With prep expose systems wait until the green LED on the relay box is blinking slowly If you have a two step syste
251. ns Insert the cassette into the scanner Note If you are using the IDEXX I Vision CR System and the scanner is unable to identify the cassette size a dialog box will appear so that you can specify the size Click Scan A scanning message appears on the screen and the light s on the front of the scanner is are green and blinking IMPORTANT While the x ray cassette is being read do not perform any other operation on your computer e g printing entering data or emailing When the scan is complete the scanner interface closes and the image is displayed in the main window In the shot tree on the right the check box next to the exam type Is checked The first image is preserved and the next exam type option is automatically selected in the list on the right The Window Level tool is active So you can adjust window and level contrast and brightness if you want by doing the following e Click and move the mouse left and right to adjust the window e Click and move the mouse up and down to adjust the level Chapter 10 Capturing Images Hodek Quality Control Crane Pump cin Figure 10 5 The Scanner Interface window TIP See Chapter 12 Checking and Approving Images for more information on ensuring the best image quality This chapter also contains instructions for enhancing the image by adjusting the window and level contrast and brightness and by reprocessing applying edge enhancement 125 10
252. nt has been tested and found to comply with the limits for a Class A Digital Device pursuant to part 15 of the FCC Rules These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment This equipment generates uses and can radiate radio frequency energy and If not installed and used in accordance with this operator s guide supplement may cause harmful interference to radio communications Operation of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense 229 Chapter 20 The IDEXX I Vision DR System 20 9 6 General Safety Information WARHIHG WARHIHG WARHIHG A WARHIHG A CAUTION The IDEXX l Vision DR System and associated cables must not be operated in the presence of moisture To avoid excessive electrical dangers proper grounding of the product is required The control box s power cord shall be connected directly to a hardwired AC Mains receptacle If an extension device is needed it must be pre approved by IDEXX The use of any other electrically powered device with the control box must be pre approved by IDEXX Do not simultaneously touch the patient and any of the cables or boxes associated with the IDEXX I Vision DR System The IDEXX I Vision DR System is not suitable for operation in the presence of a flammable an
253. nt not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide Continuous operation 15 9 3 Safety Symbols The following safety related symbol is found in this manual To avoid injury learn to recognize tt j Attention Read the CAUTION or WARNING statement that follows The following safety related symbols are found on the IDEXX DR 1417 system components To avoid injury learn to recognize them Power on Power off Operating temperature range Exposure to temperatures outside of this range could damage equipment or affect performance Fragile Handle with care Special cleaning instructions See 15 9 7 Sealed System Safety Information 158 oA a Chapter 15 The IDEXX DR 1417 Digital Imaging System Do not immerse in liquids No field serviceable component inside Do not attempt to open the case Control box main power fuse 250V AC 2 Amps Type T To identify any terminal that is intended for connection to an external conductor for protection against electric shock in case of a fault or the terminal of a protective earth ground electrode Medical equipment with respect to electric shock fire and mechanical hazards only in accordance with UL 60601 1 and CAN CSA C22 2 No 601 1 Medical Device Directive MDD 93 42 EEC applies to all medical equipment except for active implantable devices Dangerous voltage Alternating current 15 9 4 Signal Input
254. nt to apply the action to a whole study or series you only need to select one image that belongs to that study or series Click the appropriate button on the right side of the Image Explorer or right click and choose the action from the menu 3ln the dialog box that appears select Study if you want the action to be carried out on the whole study Series if you want the whole series or Image if you want only the image To begin image related actions with a right click gt In both the Image Explorer and the Image Viewer if you right click on an image thumbnail a menu appears listing actions that you can perform on the image or images that you have selected Examples of these actions include reviewing emailing or printing images from the Image Explorer and cloning or emailing images from the Image Viewer 21 3 ool Chapter 3 Importing Images via DICOM This chapter covers the ways that you can import images into the IDEXX Cornerstone Practice Management System using the DICOM Digital Imaging and Communications in Medicine standard If you have an IDEXX Digital Imaging system see chapters 10 11 and 12 for more information about capturing images with your system You can also import images into Cornerstone from a variety of different devices and scanners by other methods See Importing and Acquiring Images from Scanners Ultrasound Digital Cameras etc in chapter 26 of the Cornerstone Users Manual for m
255. ntain the working order and the operational reliability of your device As the operator of the device you must abide by the regulations for prevention of accidents and the local medical product law as well as other regulations 19 4 Inspections 19 4 1 Safety Inspections To avoid malfunctions and to ensure personnel patient and device safety IDEXX recommends annual inspections of the device These inspections are part of the preventive maintenance tasks within the scope of IDEXX Laboratories Inc service contracts Inspections include e Visual inspection for completeness and noticeable damage and defects as well as for contamination parts sticking together and wear that reduces safety e Inspection of the necessary monitoring safety display and annunciation devices e Measurement of the safety relevant output parameters e Further special technical inspections for the respective product corresponding to the generally recognized state of the art e Further necessary inspections according to manufacturer s details Note The maintenance and inspections must be carried out only by trained specialists 19 4 2 Operator Inspections The operator needs to check the device for obvious defects see table If functional defects or other deviations from normal operating conditions occur the operator must turn off the equipment and inform IDEXX Digital Imaging Support The equipment can be used again only after repair Operation with d
256. ntegration 22 1 3 Preparing for Integration The checklist below will help you gather the information you need to have on hand in order to integrate Cornerstone with a validated device Most of these information requirements apply to all levels of integration those requirements that apply only to certain levels are marked About the validated device L L L Are DICOM features currently enabled on this device Do you know how to change DICOM settings on this device Do you have user documentation for this device including the DICOM conformance statement Documentation may be printed or online Do you know the model number of the device and the version number of any additional software you use with the device If you need additional software to support modality worklist features have you installed that software and does it support MPPS Do you have a customer support agreement for the validated device For partial integration Does the validated device automatically send images to Cornerstone as it captures them Or if the device is not currently sending images automatically can that feature be set up About your computer network L L L Is the validated device connected to your practice s computer network Does the validated device use a Static IP address on your network If not can a Static IP address be set up for the device Does the device store images somewhere on the network other than on the device itself
257. o have the Advanced Search displayed when the Image Explorer window appears select Show Advanced Search on Image Explorer 4 Click Save to save and close the Staff Defaults window or click Apply to save without closing the window 112 Chapter 8 Setting Up Basic Imaging Features 8 15 Setting Up Modality Layout These tools are available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software You can set up how you want images to be displayed on the Image Viewer window based on the modality of the images Images with a modality of Intra oral Radiography are set up in a slightly different manner than images from other modalities Note When you change these settings you are changing how all images of that modality are displayed For example if you change the settings for arranging DR images in the viewer the new settings will apply any time you look at DR images To set Image Viewer display formats for Intra oral Radiography 1 On the Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Modality Layout 3 Select the image modality from the Modality drop down list 4 Select a dental template from the Template drop down list The template layout is displayed in the Preview area of the window The Study Layout area and the Series Layout area do not apply 6
258. o not modify this product in whole or in part without prior written approval from IDEXX Personnel operating and maintaining this system should receive training and be familiar with all aspects of operation and maintenance To ensure safety read all user manuals carefully before using the system and observe all Cautions Importants and Notes located throughout the manual Keep this manual with the equipment Reading this manual does not qualify you to operate test or calibrate this system Unauthorized personnel are not allowed access to the system Use only legally marketed cassettes Check periodically the quality of the cassettes and replace them if any defects are apparent The images provided by this system are intended as tools for the trained user They are explicitly not to be regarded as a sole incontrovertible basis for clinical diagnosis Be aware of the product specifications and of system accuracy and stability limitations Consider these limitations before making any decision based on quantitative values If you have any doubts consult your sales representative This system is Class continuous operated stationary equipment without applied parts and has one signal input output part In order to guarantee medical grade leakage current the scanner manufacturer recommends that the computer that is connected to the system should be a medical grade computer or connected to the mains through a medical grade isolation transfo
259. o open it from the Cornerstone Practice Management Software If you submit a case directly through the telemedicine provider s Web site the status will still be visible on the Image Explorer and you will still be able to open reports from the Cornerstone software In most cases Cornerstone matches these submissions to the proper patient Note To use the IDEXX integration technology for telemedicine and remote consult features you first need to set up your Cornerstone software to communicate with your telemedicine providers Web sites See 8 11 Setting Up Remote Consult and IDEXX Integration Technology for Telemedicine 4 1 About the Case Detail Window The Case Detail window is used to create and manage cases At the top of the window is information about the patient Below the patient information are three panes each of which can be opened or closed e The Case Information pane displays information about the case In this pane you can give the case a title note which staff member is associated with this case and you can record the specialist s comments on the case e The Thumbnail pane displays thumbnail versions of the images in the case On this pane you can add and remove images and documents from outside of the Cornerstone software e The Case Actions pane allows you to send the case out of Cornerstone in a number of ways When you select one of the tabs at the top of this pane the pane displays the options you need
260. o search without these text boxes no search results will be displayed For example a search using only date text boxes does not work if the exact match or number of characters option is specified 4 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 7 Setting Up Imaging To set up imaging 1 Onthe Controls menu select Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select Imaging 101 Chapter 8 Setting Up Basic Imaging Features In the Image Scan Settings area do the following a Select your scanner in the TWAIN Source text box n TIP While compressing an image b Adjust the resolution values in dots per inch dpi in the Horizontal Resolution and Vertical often reduces the time needed to Resolution text boxes transfer images it also reduces c Adjust the pixel type black and white grayscale or color in the Pixel Type text box image quality d If you want Cornerstone to use your scanner s user interface when you scan an image select Enable TWAIN UI In the Image Viewer area select the unit of measure centimeters millimeters or inches for the Ruler annotation tool in the Image Viewer In the Image Capture Settings area do the following a From the Distance Units drop down list select the default unit for measuring the distance between the x ray plate and the x ray source Distance can be measured in feet
261. o start on the Imaging Dashboard screen Click to select a request in the Open Requests list and then click Capture Images or just double click the request The Capture Setup window appears with the exam types for the request already selected in the Choose Exam Type area 2 At the top of the window your user name should be displayed in the Technician text box but you can choose a different name from the drop down menu 3 The Veterinarian text box should display the name of the veterinarian for whom you are capturing the images but you can choose a different name from the drop down menu 4 Click Next to move on to the Ready for Capture window The first radiograph is highlighted in the shot tree menu on the right Follow the instructions in Chapter 10 Capturing Images to take the requested radiographs When you have finished taking all the images for this patient click Done Capture 22 5 6 Using the Image Request Special Action Item Report The new Image Request Special Action Item Report provides a listing of service type invoice items by modality types that have been set up to initiate the Image Request special action Fields listed on the report include item ID invoice item description amount exam description and any preselected shots associated with the item The new report is available in the Invoice Item report group The following options are available on the report e Sort options for the report include invoice it
262. o the version of the image that you saved at the end of the capture process by using the Revert to Original tool If you are using an IDEXX Digital Imaging System you can also return to a raw version of the image but with new edge enhancement applied by using the Reprocess tool a The Open tool allows you to open images from various sources and import them into Cornerstone Select the Open tool and then select an image type from the drop down list A dialog box appears where you can specify the source and type of file you want to bring into Cornerstone For more information about using this tool see Importing and Acquiring Images from scanners Ultrasound Digital Cameras etc in chapter 26 of the Cornerstone User s Manual 41 Chapter 5 Reviewing Images The Save tool saves the image to a file Click the tool and select Save to save changes to the image or video file you are viewing When you click the tool and select Save As a dialog box appears where you can enter a name for the image and select a format in which to save it The format choices in the dialog box are bitmap JPEG JPEG 2000 RAW TIFF DICOM as well as the AVI MPG MPEG MP4 video formats Click Save to complete the process The Reprocess tool is available if you are using certain IDEXX Digital Imaging Systems see 12 3 Advanced Image Enhancement Reprocessing for more information The Edit Image Details tool opens the Image Details dialog
263. o top to increase the level e Top to bottom to decrease the level To apply a Window Level preset gt Click the Presets tool and select the preset you want to use The window and level values for the image are changed For more information see 8 10 Setting Up Window Level Presets 12 2 Other Image Enhancement Tools To use the Magnify tool gt Click the Magnify tool S then click the desired area on the image to zoom in To use the Fit to Window tool gt Click the Fit to Window too Gai to toggle between scaling the image so that it fits in the viewing window and showing the image at 100 scale where the image on the monitor is the same size as the image recorded on the detector or screen To use the Invert tool gt Click the Invert tool to reverse light and dark values The Invert tool lets you check the image as a black bone image and as a white bone image and vice versa 140 Chapter 12 Checking and Approving Images 12 3 Advanced Image Enhancement Reprocessing Reprocessing modifies the image processing applied to an image Most of the time you will not need to reprocess radiographs IMPORTANT When you reprocess a radiograph you remove the current image processing and apply new enhancement settings Previous changes made to the image such as rotating adjusting window and level contrast and brightness and adding annotations are undone 12 3 1 Reprocessing with ClearCapture Dx
264. ocation in the text box or click Browse and browse to the folder that you want to use 4 Doone of the following a Inthe Medical Notes SOAP text box type any notes that you want saved on the CD These notes will be saved in a text file labeled with the name of the case b To add medical notes SOAP from the patient s medical history i Click Medical History li Select the medical notes to include by using the Medical Notes SOAP Selection Screen dialog box iii Click OK The medical notes you have chosen are displayed in the Medical Notes SOAP text box where you are able to edit them 5 If you want to add annotations or overlays to the JPEG files that will be included on the CD click Apply Annotations and or Apply Overlays select a location in the Save In drop down list and click Save 7 Click OK The Patient CD Progress box appears When the files are finished the Patient CD complete message is displayed 8 Click OK to close the Patient CD Progress dialog box 33 Chapter 4 Cases and Telemedicine 4 5 2 Emailing Case To email a case ik 2 3 On the Case Detail window if the Case Actions pane is not open click Expand gt gt Click the Email tab The email options are displayed In the To text box type the email address for the specialist to whom you are sending the case or select the address from your address book by doing the following e Click Address Book The Address Book dialog box a
265. ocess To complete the capture process gt When you have finished taking images and adjusting them click Done Capture in the lower right corner of the window The window on which you began the image capture process Is displayed On the Patient Clipboard the image series that you just captured is shown in the Patient History area On the Imaging Dashboard the image study that you just captured appears at the top of the Most Recent Studies list On the Image Explorer thumbnails of the images that you just captured are shown 129 Chapter 11 Image Coach and Other fools 11 1 Image Coach Features several tools on the Image Capture window offer real time information and feedback to help you e Confidently capture the best possible radiograph on the first try e Train new technicians e Encourage standard radiography practices for all staff members e Troubleshoot problems related to under or overexposed images Note Image Coach is not available for mobile laptops or for IDEXX CR 1417 systems that do not have ClearCapture Dx software installed 11 1 1 Real time Positioning Aid Before you capture a radiograph you can see a photograph that shows how the patient should be positioned Hints for proper positioning also appear To display the positioning aid gt Onthe right side of the Image Capture window click Position E d A photograph appears showing the proper patient positioning Next to the photo is a text description of the
266. odel 140 or 140R Digital Imaging System Note Screens are either white on one side and black on the other Kodak or CARESTREAM screens or white on both sides The scanner manufacturer recommends using CARESTREAM formerly Kodak screen cleaner to clean Kodak and CARESTREAM imaging screens To obtain screen cleaner contact IDEXX Digital Imaging Support at 1 877 433 9948 IMPORTANT CARESTREAM screen cleaner should be used only with Kodak or CARESTREAM screens AN Read and follow the instructions in the manufacturer s Material Safety Data Sheet MSDS prior to use CAUTION Never insert an imaging screen into a cassette unless the screen and cassette are PTET thoroughly dry Figure 17 7 The extraction tool Do not use alcohol or alcohol based products on Kodak or CARESTREAM screens Avoid E letting the imaging screen come in contact with isopropyl alcohol isopropanol rubbing Z caution alcohol hydrogen peroxide and other peroxides citrus based cleaners hand lotions and waterless hand sanitizers as well as surfactants and lubricants These materials may cause visible or hidden damage to the screen and could result in immediate or future image artifacts To remove the imaging screen for cleaning Remove the screen 1 Slide the edge of the extraction tool provided with your scanner over the back edge of the Figure 17 8 Installing the extraction cassette Pull the tool down until it enters the square slots in the back to
267. og entry highlight the row and click Delete Entry Note You can only delete entries that you have added manually Entries created automatically by the Cornerstone software cannot be deleted 86 3 Chapter 7 Other Tools and Tasks e To modify information that was not entered automatically by the software click in the text box and edit the text e Fill in any of the following text boxes for which you want to record information x i renege Come Se ees eet te Sacer Fabre liris Dai Teig PHE Ag o Thickness lype the thickness of the ce Pale Redwerephn atir L thktemestn eperrak barena mas body part being imaged arzo imapa 1 Espina z Tia fn E Radiology Log Liar Se brigepe i Peco dary l on oo o Exposure mAs Type the amount of x ray E wn Lial Aea b T A exposure in milliampere seconds mAs This is calculated automatically if you enter values in the Exposure mA and Exposure time sec text boxes o Exposure mA Type the amount of current in milliamperes mA o Exposure time sec lype the duration of the exposure in seconds as a decimal value or use the drop down menu to select a fraction of a second o Exposure kVp lype the amount of voltage peak kilovoltage used for this image cach ae PET Figure 7 1 The Radiology Log for a patient o Level of sedation Select from the drop down menu o Use of Grid Select the check box if a grid was used Note If you added
268. ogram has been set up for automatic auto routing the images are sent without requiring any user intervention To check the progress of the images as they are being sent or to pause restart or cancel image sending see 6 4 Using the DICOM Queue 136 Chapter 11 Image Coach and Other Tools To send images via semi automatic auto routing If the program has been set up for semi automatic auto routing follow these instructions when the send DICOM dialog box appears at the end of the image capture process 1 Inthe Images to Send box which lists the images you have captured select images to send by holding down the CTRL key and clicking the images you want 2 Inthe Remote Servers box select the destination to which you want to send the images If you want to send the images to more than one destination hold down the CTRL key and click the destinations you want 3 Click Send to send the images To check the progress of the images as they are being sent or to pause restart or cancel image sending see 6 4 Using the DICOM Queue 137 Chapter 12 Checking and Approving Images Chapter 12 Checking and Approving Images Before you save the images you ve captured you should check over your images in the Capture window just as you would conventional images The only difference is that with Digital Imaging features of the IDEXX Cornerstone Practice Management System you will be doing this digitally There are three im
269. ol allows you to turn the image overlays on and off The Toggle Ruler tool turns the ruler on or off The ruler appears along the top and left side of the image A marker on each side of the ruler shows the current position of the mouse pointer or imaging tool within the image Click the Toggle Ruler tool again to hide the rulers WARNING The ruler is only accurate if the system has been calibrated for this type of image or if this image has been calibrated with the Calibration tool e f the system and or image is not yet calibrated when you click the Toggle Ruler tool a dialog box notifies you that the ruler is not calibrated See the Calibration tool instructions for more details e f the system and or image is not calibrated the ruler scales appear but are not labeled After you have used the Edit Series Layout tool in the Display Configuration toolbar the Lock tool allows you to synchronize the images within one series to images in one or more other series This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software This allows you to compare images from different series easily For each series bring up the image where you d like to start After you click the Lock tool when you scroll through one series the images in the other series move in sync Click the Lock tool again to turn off this
270. ol onto the back of the cassette of the cassette 2 Hold the cassette horizontally Locate the cassette slider in the extraction tool s central pecie opening Push the slider towards the edge of the cassette until the edge of the screen is visible 4 Carefully pull the screen out and place it on a clean dust free surface Note Observe which side of the screen faces the top side toward the x ray tube This is the side to be cleaned _____ Extraction Tool z Figure 17 9 The edge of the screen Clean the screen emerging from the cassette 1 Fold a nonabrasive lint free cloth and dampen with a small amount of cleaner or distilled water Do not pour the cleaner directly onto the screen Excessive amounts of cleaner may damage the screen a 2 3 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System Wipe the screen gently and thoroughly one section at a time Fold the cloth to expose a fresh area for each section of the screen If necessary for the removal of persistent dirt apply pressure while cleaning Return the screen to the cassette 1 After cleaning wipe the screen thoroughly dry with a clean dry nonabrasive lint free cloth or wipe to remove residual cleaner Do not leave the screen to air dry CAUTION Never insert a screen into a cassette unless it is completely dry When the screen is dry position it so that two or three inches hang off the edge of a clean dust free surfac
271. ology log entries are automatically recorded but you need to record exposure information later You can do this on either o On the log itself for a particular patient or for all patients o On the Image Detail dialog box for a particular image either during the capture process or when reviewing the image e lf you capture and store images outside of Cornerstone you can manually create a log entry and add radiology log information on the Radiology Log window Once a log has been generated you can view the entire log or a portion of it and can print it email it or export it as a PDF Portable Document Format file Note With the addition of the Radiology Log feature in Cornerstone 8 1 and higher you no longer need to use the Cornerstone Radiology Imaging Template Classic medical note 7 5 1 Recording and Editing Radiology Log Information To record or edit log information for a patient 1 On the Patient Clipboard with a patient selected right click in the Patient History area and select Radiology Log Ihe Radiology Log window appears displaying log entries for this patient 2 Inthe table you can add entries or modify any information that wasn t automatically recorded by Cornerstone e Scroll down to see all the entries and scroll to the right to see all the information for each image e To add a log entry manually click Add Entry and enter information in the row that is added to the table e Jo delete a l
272. ompliance RF emissions Group 1 CISPRA RF emissions Class B CISPR 11 Harmonics emissions Class A IEC 61000 3 3 Voltage fluctuations Complies flicker emissions IEC 61000 3 3 Electromagnetic environment guidance The scanner uses RF energy only for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The scanner uses RF energy only for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The scanner is suitable for use in all establishments including domestic establishments and those directly connected to the public low voltage power supply network that supplies buildings for domestic purposes 193 Chapter 18 The IDEXX I Vision CR Digital Imaging System Guidance and manufacturer s declaration electromagnetic immunity The scanner is intended for use in the electromagnetic environment specified below The customer or the user of the scanner should assure that it is used in such an environment Immunity test IEC 60601 test level Compliance level Electrostatic 6 kV contact 6 kV contact discharge ESD 8 kV air 8 KV air IEC 61000 4 2 Electrical fast 2 kV for power 2 kV for power transient burst supply lines supply lines IEC 61000 4 4 1 kV for input 1 kV for input output output lines lines Surge 1 kV line to line 1 kV line to lin
273. on The IDEXX DR 1417 system and associated cables must not be operated in the presence of moisture WARHIHG i To avoid excessive electrical dangers proper grounding of the product is required The Control Box s power cord shall be connected directly to a hardwired AC Mains receptacle If an extension device is needed it must be pre approved by IDEXX The use of any other electrically powered device with the Control Box must be pre approved by IDEXX WARHIHG The IDEXX DR 1417 system is not suitable for operation in the presence of a AN flammable anesthetic mixture with air oxygen or nitrous oxide WARHIHG The Detector Panel must not be carried by its connecting cable CAUTION Note Follow all safety labels on the equipment 15 9 7 Sealed System Safety Information The detector panel is sealed so that biological fluids will not penetrate the outer casing during normal use The exterior of the plate carbon panel can be cleaned with common decontamination solutions including 20 chlorine bleach solution 1 part bleach to 4 parts water A 5 gluteraldehyde or 70 alcohol solution can also be used To apply the cleaning solution power down the system and disconnect from power source moisten a cloth with the solution and wipe the panel 160 Chapter 15 The IDEXX DR 1417 Digital Imaging System Note The user must follow standard cleaning and decontamination policies and procedures Do not spray cleaning solution direct
274. on 4 IDEXX I Vision Mobile Application Chapter 23 Using the Mobile Application 23 1 Overview With the IDEXX I Vision Mobile Application you can review radiographs with clients on an iPad or Android mobile tablet anywhere in your practice You can queue image capture requests remotely and the application notifies you when radiographs are captured or telemedicine results are received You can also send images to external systems via DICOM email and telemedicine right from the tablet Note The mobile application is built to run on tablet devices iPads or Android devices It is not recommended for tablet PCs or smaller devices like cell phones An IDEXX representative needs to set up your network to support the application After that you can set up new tablets to use the application by following the instructions in section 23 3 Setting Up the Application on New Tablets 23 2 Primary Work flows This section gives you a high level view of the primary work flows in the tablet application For more detail see 23 4 The Screens in Depth II of the work flows begin on the application s opening screen the Patient List screen 23 2 1 Viewing Images To view images 1 2 3 4 Locate a patient on the Patient List screen Tap the patient On the Patient Summary screen tap an image to select it and tap again to view it See the Viewer instructions in this chapter for more information 257 Chapter 23 U
275. on Regarding Small Detail Object Imaging As with all digital imaging devices there is the potential that small detail structures high contrast edge structures and fine line structures with a repeating pattern could appear differently in the digital image than in an image created with an analog device such as a screen film system or with another digital device having smaller individual detector elements For example for a sharp edged object the edges of that object may appear to have stair step when in fact the object edge does not have such structure This is an effect of digital under sampling For small detail objects having a size on the same order of magnitude as an individual pixel or smaller the apparent contrast of that object can vary based on the position relative to the individual detector element locations For example the contrast of a single spherical object the same size as a pixel would have a dramatically different appearance if the object were imaged directly overlying a detector element highest contrast than it would if placed at the intersection of four detector elements lowest contrast Objects inherently smaller than an individual pixel have a radiation intensity signal over an area larger than the small object In each case a lower apparent signal to noise can result in reduced visibility of such objects 162 Chapter 16 The IDEXX CR 1417 Digital Imaging system IMPORTANT The instructions in this chapte
276. on via email DICOM or CD DVD e g to specialists for consultation Assigning categories to your cases lets you find all of a patient s cases with the same category designation or find all cases that match a selected category To add a category for cases 1 Onthe Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select Case Categories Click Add to add a line to the Case Categories table Enter the category description up to 30 characters or ge a o Repeat this process to add other categories When you are finished click Save to save and close the Imaging Configuration window or click Apply to save without closing the window To update a category in the list 1 Select a category in the list 2 Type your changes 3 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 8 3 Setting Up DICOM Services The DICOM Digital Imaging and Communications in Medicine standard allows for the transfer storage and printing of digital images in various software programs or equipment regardless of the manufacturer The DICOM standard is both an image file format and a communication protocol that allows for the exchange of medical images between devices such as a computer workstation and a printer between two networks or between an imaging capture device and a computer The DICOM image file format standard defines the dataset t
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278. or DVD so the recipient of the disk will need to have software that can display the images 1 On the Case Detail window if the Case Actions pane is not open click Expand gt gt 2 Click the Export tab The export options are displayed 3 Select CD DVD to save the case to a CD or DVD Note If you want to save the case to a file location select File Folder and choose a file location You might do this if you wanted to save the case onto a USB flash drive or to compile the burn the case onto CD at a later time using the CD burning capabilities in the Windows operating system 4 Do one of the following a Inthe Medical Notes SOAP text box type any notes that you want included in the text file that will accompany the case These notes will be saved in a text file labeled with the name of the case b To add medical notes SOAP from the patient s medical history i Click Medical History li Select the medical notes to include by using the Medical Notes SOAP Selection Screen dialog box lil Click OK The medical notes you have chosen are displayed in the Medical Notes SOAP text box where you are able to edit them 5 select the type of file that the Cornerstone software should use to export the images in the Export File Type text box Figure 4 5 The Case Actions pane showing the Export tab Note To set a default value for this text box see 8 5 Setting Up Export Defaults 6 Ifyou want to add annotations or overlay
279. or add the entire study to which the image belongs Note For more information about image series and study see 2 3 About Image Series and Study Click Select The Select Case dialog box appears In the Select Case drop down list select the case to which you want to add the images Click OK The Case Detail window appears and the information in the Case Details and Thumbnails area reflects the additional images If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter To remove images from a case 1 2 On the Case Detail window if the Thumbnails pane is not open click the Thumbnails header Select the thumbnail for the image that you want to remove If you want to delete more than one hold down the CTRL key and click additional thumbnails Click Remove The images you selected are removed from the case If you do not want to do anything else with this case click Save and Exit If you want to do a case action follow the instructions later in this chapter Chapter 4 Cases and Telemedicine 28 4 3 2 Adding and Removing Outside Images and Other Attachments To add images or documents from outside Cornerstone 1 On the Case Detail window if the Thumbnails pane is not open click the Thumbnails header 2 If you want to attach supporting material such as documents images or other files that are not stored in
280. or which you know the measurement 2 The Calibration Settings Annotation dialog box appears Click the Calibration Settings tab 3 Select the unit you want to use Such as inches or centimeters from the list in the Measurement Units area 4 Inthe Length text box type the number of those units inches centimeters etc that matches the length of the line on the animal 5 When you finish entering information click Save The dialog box closes and the image is displayed in actual size The Calibrated overlay for this image reads Calibrated true Note This calibration setting remains accurate as long as the distance between the x ray source the x ray plate remains the same If the source to plate distance changes you must recalibrate by repeating steps 1 through 5 When you recalibrate the calibration settings will be applied to all radiographs captured with this modality For this reason the calibration tool is most useful in small animal radiography where the distance between the x ray source and the x ray detector is unlikely to change Ellipse Click and drag to draw a circle or oval around part of an image Freehand Line Click and drag to draw a freeform line Protractor Click and drag to draw specific angles on the image Click to place the endpoint of one line drag a line to the corner of the angle and release Then click to place the endpoint of the second line The angle measurement between the two line
281. ore information Importing Individual DICOM Images To Import a DICOM Image 1 Do one of the following e On the Patient Clipboard right click in the Patient History area and select Image Import DICOM The Open dialog box appears e On the Image Explorer window click Import DICOM e lf you have a patient selected the Open dialog box appears e lf you do not have a patient selected the Select Client and Patient dialog box opens so that you can select the patient Use the search function if necessary select the patient in the Search Results table and click Select The Open dialog box appears 2 On the Open dialog box select the directory in the Look In drop down list and the browsing area below it Note If the DICOM file is not displayed in the browsing area select All Files in the Files of Type drop down list Some devices create DICOM files that do not end in the dcm or dic file extensions select the DICOM file in the browsing area The file name appears in the File Name text box Click Open If the Import DICOM dialog box appears the information in the DICOM file does not match this patient s information in Cornerstone exactly Click Yes to continue importing or click No to end the import process The image appears on the Patient Clipboard or Image Explorer window 22 Chapter 3 Importing Images via DICOM 3 2 Using DICOM Query and Retrieve to Import Images from Remote Servers The DICOM query and retrieve
282. ot tree area on the right of the Image Capture screen the first exam type in the list is 1 OO ee automatically highlighted e To take this image continue with step 2 Chapter 10 Capturing Images e To take a different image click the exam type for that image to highlight it IMPORTANT For best image quality the body part that you are imaging must match the exam type that is highlighted The exam type that is selected in the shot tree determines image processing values and the image orientation Use the technique chart that was provided by your installer to select suitable settings on your x ray equipment for exposure time and kVp Position the animal on the table and take the x ray Insert the cassette into the scanner Click Capture Image The Scanner Interface screen appears In the top right of the Scanner Interface window click one of the following buttons 1 for table top 2 for grid tray Note Buttons 3 and 4 can be set up for additional tables If you are using ClearCapture Dx software select 1 for companion animals 2 for exotic animals or 3 for horses On the left side of the Scanner Interface window click the desired anatomical region button and then click the size on the pop up menu Note The anatomical region buttons that appear along the left side of the Scanner Interface window change based on which of the number buttons is selected in the upper right Click Scan the large button in the b
283. ottom left The Initializing scanning message appears followed by the Scanning message Note While the image is being read the LED on the IDEXX CR 1417 Scanner turns orange You can view the image in the Image Preview window A countdown timer indicates the time left for reading the plate Be RECENT Figure 10 4 The Ready for Capture screen with the Scanner Interface Window TIP The shot tree menu contains other features that allow you to customize your image capture session See 11 3 Dynamic Shot Tree Features for Capture for more information on e Adding an exam type e Looking at the images you have taken IMPORTANT While the plate is being read do not perform any other operation on your computer e g printing entering data or emailing 123 Chapter 10 Capturing Images When the scan process is complete you will see a Saving Image Please Wait message The scanner interface closes and the image is displayed in the main window In the shot tree on the right the check boxes next to the exam types for the images in the first series are checked 9 The Window Level tool is active so you can adjust window and level contrast and brightness If you want by doing the following e Click and move the mouse left and right to adjust the window e Click and move the mouse up and down to adjust the level e Click the Presets tool and select Original As initially displayed restore window and le
284. own in the diagram and turn on the temperature control This ensures that the plate is always transported and stored in the optimum temperature range If the ambient temperature rises above 80 F 27 C or falls below 50 F 10 C make sure the case is connected to a main power supply or to i On Off switch the 12 volt electrical system of your vehicle and is turned on The combined heating and cooling element Peltier element maintains Indicator LED the temperature inside the case reliably below 95 F 35 C even in the Peang event of external temperatures up to 120 F 48 C The case must be supplied with power using only the cable provided The case can be e connected to a main power supply 100V 240V on Connector 1 or to a E E peciecontial 12 volt vehicle electrical system Connector 2 Insulation ensures that the temperature within the case changes very Connector 1 slowly The red LED indicates temperatures below 60 F 15 C and PREAUN that the temperature control module has automatically turned on the Connector 2 heating The green LED indicates temperatures above 95 F 85 C and 12V DC that the cooling function is active If the temperature range is above 60 F 15 C or below 95 F 35 C none of the LEDs light up the temperature Figure 19 3 X ray plate transport and storage case in the case is within the allowable temperature range and is displayed on the temperature control module When heating or coo
285. ows an exchange of information between Cornerstone software and IDEXX Digital Imaging systems This allows you to request digital images electronically anywhere in the clinic instantly capturing requests and charges in patient records and on invoices This integration reduces missed charges and preserves x ray revenue In addition to integration with an IDEXX Digital Imaging system IDEXX SmartLink Digital Imaging includes the modality worklist integration features described below IDEXX PACS software is a prerequisite to using IDEXX SmartLink Digital Imaging Note In some instances you may be able to purchase IDEXX PACS software as an upgrade even if you do not have an IDEXX Digital Imaging system For more information contact your IDEXX Cornerstone sales representative at 1 800 283 8386 22 1 2 Integration with Third party Imaging Systems Cornerstone 8 3 introduces Modality Worklist Integration which offers a similar request work flow for other non IDEXX imaging systems This means that in addition to requesting and receiving images from IDEXX Digital Imaging systems you can now create and manage image requests directly from Cornerstone for non IDEXX imaging systems that are compatible with the Modality Worklist functionality of the DICOM standard 239 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration IDEXX supports modality worklist connections for systems where we have tested and validated
286. ox specify the desired amount of magnification The Zoom tool allows you to zoom in to or out of an image Click the Zoom tool and then click and drag the mouse Move up to zoom out the image gets smaller or down to zoom in the image gets larger Note Be sure to release the mouse button completely between zooming in one direction and zooming in the other direction Also be sure that the mouse pointer is within the Cornerstone window when you click to begin the zoom action The Pan tool allows you to click and drag the image to move it within the window The Invert tool automatically inverts the colors in your image white becomes black and black becomes white The Crop tool allows you to cut out unwanted parts of an image To crop an image select the tool then click and drag the crop border so that it contains the part of the image you want to keep Right click inside the border and select Apply Crop The image is cropped to the selected area Tips e To adjust the border click and drag an edge of the rectangle e To rotate the crop area click and drag one of the corners Note You might want to rotate the crop area to adjust the appearance of the image For example if the patient and the image detector cassette were not aligned and collimation produced an irregular white area you could crop to exclude it from the image The Restore Original tool allows you to return the image to the way it looked when you clicked Done Ca
287. p SmartLink Digital Imaging in a version of Cornerstone earlier than 8 2 these enhancements require some changes to your invoice item setup and possibly to your practice work flow e f you re making the transition from the older version of SmartLink Digital Imaging and you re familiar with special actions you may be comfortable setting up the new version on your own See Overview of Steps Transitioning Your SmartLink Digital Imaging Invoice Item Setup below for instructions e If you re making the transition from the older version of SmartLink Digital Imaging but aren t familiar with special actions please take a look at Overview of Steps Transitioning Your smartLink Digital Imaging Invoice Item Setup below If you feel you need assistance to follow these instructions call Cornerstone Support at 1 800 695 2877 Once you ve set up SmartLink Digital Imaging see 22 5 Using Imaging Integration Overview of Steps Transitioning Your SmartLink Digital Imaging Invoice Item Setup 1 Using the examples in the following section begin to rethink the way you bill for radiographs By transitioning to a multiple shots per invoice item setup as outlined in the examples your 239 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration imaging work flow and billing can be made more efficient and accommodating to the unique needs of your practice 2 Set new image request preferenc
288. parallel lines for the vertebrae The top and bottom vertebral lines are linked to the heart lines and will change size as the heart lines are adjusted The middle vertebral line is used to measure several vertebrae so that the software can calculate an average vertebra length By default the VHS is calculated based on a measurement of five vertebrae to change this see To change VHS tool settings below The VHS value also appears It is initially displayed as N A but is calculated when you adjust the measurement lines s 3 Click Zoom and zoom in so that you can see the relevant details of the image This will also make it easier to work with the lines Click the annotation Pointer Adjust the measurement lines on the image of the heart a Click on a line to move it into position The heart lines are labeled Short Axis and Vertical Axis and can be moved independently b Click the handle on the end of a line and drag to change the size of the line 6 Adjust the vertebral measurement line a Click on the middle line to move the set of vertebral lines into position b Click the handle on the left caudal end of the middle line and drag so that the line measures the width of five vertebrae or a different number if you have changed the tool settings 53 Chapter 5 Reviewing Images 7 Note the resulting VHS value Note Although the VHS is automatically recalculated you can recalculate the VHS at any
289. portant questions 1 Did get the right image 2 Is the image oriented properly 3 Does the image look right The sections below describe how to adjust the images you ve captured so that the answers to all three questions are yes 12 1 Did Get the Right Image Is the animal properly positioned in the image If the animal was not centered on the plate use the Crop tool to recrop the image to center the animal in the image You can also use the Crop tool to remove any white collimation lines from the edges of the image The Pan tool lets you position the image within the viewing window To use the Crop tool ee gt Click the Crop tool Ss and then click and drag to draw a crop border around the area of the image that you want to keep Right click within the border to crop the image The area outside the border is no longer part of the image Tips e To adjust the border click and drag an edge of the rectangle e To rotate the crop area click and drag one of the corners Note You might want to rotate the crop area to adjust the appearance of the image For example if the patient and the image detector cassette were not aligned and collimation produced an irregular white area you could crop to exclude it from the image To use the Pan tool gt Click the Pan tool Ww and then click and drag the image to move it within the boundary box 138 Chapter 12 Checking and Approving Images 12 1 1 Is the Image Orien
290. ppears 2 Ifthe image you want is not already displayed in the main Image Viewer window double click the thumbnail for that image Click Edit Image Details ty The Image Details dialog box appears 4 Click OK to close the Image Details dialog box You do not need to do anything else in this dialog box Click Save 5 and select Save from the drop down menu If you want to convert more than one image in a series select each image to bring it up in the main Image Viewer window and repeat the resaving process 7 When you have finished converting images click the X in the upper right corner of the Image Viewer The Image Viewer closes In the Image Explorer the thumbnails for the images you have converted show small versions of the images 146 Chapter 14 setting Up IDEXX Digital Imaging system Features This chapter covers setting up features of the IDEXX Cornerstone Practice Management System which are only available to users of IDEXX I Vision CR IDEXX CR 1417 including Model 140 and 140R IDEXX DR 1417 and IDEXX EquiView Digital Imaging systems For information about setting up other diagnostic imaging features see Chapter 8 Setting Up Basic Imaging Features For information about setting up basic imaging features see chapter 6 Setting Cornerstone Imaging Defaults in the Cornerstone Administrators Manual 14 1 Setting Up Dashboard Window Lists The Dashboard window contains lists of the most recent clients p
291. ppears Pemai e Select an address and click OK The address is displayed in the To text box Do one of the following a Inthe Medical Notes SOAP text box type any notes that you in the text file that will accompany the case These notes will be saved in a text file labeled with the name of the case b To add medical notes SOAP from the patient s medical history i Click Medical History li Select the medical notes to include by using the Medical Notes SOAP Selection Screen dialog box iii Click OK The medical notes you have chosen are displayed in the Figure 4 4 The Case Actions pane showing the Email tab Medical Notes SOAP text box where you are able to edit them select the type of file that the Cornerstone software should use to email the images in the Email Attachment File Type text box If you have chosen a file type other than DICOM and you want to add annotations or overlays to the files that will be emailed click Apply Annotations and or Apply Overlays Do one of the following e To email the case select Send e To save this case to send later click Save and Exit Note If you receive a message or warning about the safety of sending the email click OK 34 Chapter 4 Cases and Telemedicine To export a case to a CD or DVD You can create a CD or DVD containing case images and notes Unlike the patient CD option this method does not put a streamlined version of the Cornerstone Image Viewer on the CD
292. pture at the end of the image capture process Chapter 5 Reviewing Images TIP When you click the Zoom tool you can also use the scroll wheel on your mouse to zoom in and out 47 The Print tool allows you to print the currently selected image Click the Print tool to display the Print Preview window In this window you can view the pages you are about to print When you are ready to print click the Print icon in the upper left corner of the window Display Configuration Tools Clicking the Display Configuration Toolbar tool opens a set of tools that you can use to change how images are displayed in the viewer The Edit Modality Defaults tool allows you to set up how you want images to be displayed in the viewer based on the image modality Note When you change these settings you are changing how all images of that modality are displayed For example if you change the settings for arranging DR images in the viewer the new settings will apply any time you look at DR images Click this tool to display the Modality Layout Preferences dialog box where you can do the following 1 Select the image modality from the Modality drop down list 2 If you choose Intra oral Radiography select a dental template from the Template drop down list The template layout is displayed in the Preview area of the window 3 If you choose any other modality e inthe Study Layout area set up how individual series are displayed within
293. r Maintenance and Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 The imaging screens should be kept free of dust and debris Follow these guidelines e Wipe the cassette with a cloth and a mild general purpose cleaner e Manually remove the imaging screen from the cassette by depressing the two tabs on the end This will release the screen and allow it to slide from the slotted end Swab the active surface of the imaging plate with ethanol soaked gauze or lint free wipes Take care not to scratch the active Surface during cleaning 16 4 IDEXX CR 1417 Imaging Cassettes 5 The imaging screen for the IDEXX CR 1417 system scanner is contained within a cassette and should remain there for normal use The only time a screen is out of the cassette during normal use is when the reader automatically loads the plate for reading Note The imaging screens must be erased in the reader after each exposure In addition they o o must be erased before use if they have not been erased in the previous 24 hours 16 5 Technical Specifications Processing time Under 2 minutes i o o C Spatial resolution 5 10 pixels mm Figure 16 3 The IDEXX CR 1417 system cassette Contrast resolution 12 bits pixel Dimensions 30 7 x 25 2 x 13 4 78 cm x 64 cm x 34 cm Weight 88 Ib 40 kg Power consumption 120 VA 100 240 VAC
294. r Studies The ability to delete images or studies depends the security settings associated with your user name To delete an image in the Image Explorer 1 2 3 Click the image s thumbnail to select it Click the Delete button in the column on the right or right click and select Delete from the pop up menu The Confirm dialog box appears Click Yes The image is deleted To delete a study in the Image Explorer 1 2 Click the study in the Results Detail area to select it Click the Delete button in the column on the right or right click and select Delete from the pop up menu The Confirm dialog box appears Click Yes The study is deleted 7 4 Updating an Image Record The image record consists of the image title source date the staff member who created the image comments and keywords associated with an image 1 2 In the Image Explorer select the 9 and click Review The Image Viewer window appears Click the Edit Image Details tool The Image Details dialog box appears Chapter 7 Other Tools and Tasks 85 Chapter 7 Other Tools and Tasks 3 Edit the existing information and comments as desired See 5 13 Editing Image Details for more information 4 Click OK to save your changes 7 5 Using the Radiology Log The Radiology Log feature in Cornerstone offers several ways to record log entries and add or edit information e lf your images are stored within Cornerstone radi
295. r Tools and Tasks 89 Chapter 7 Other Tools and Tasks 2 Use the buttons on the right to print email or export the log to a PDF file e To email click Email Log fill in the text boxes on the Email dialog box and click Send The log is sent as a PDF file attached to your email e To print click Print Log The Print Preview window appears where you can view the log as it will be printed and can click Print to print it e To export the log as a PDF file click the Export as PDF link below the table The Save As dialog box appears Select a location in the Save In text box or the browsing area below it type a name in the File Name text box and click Save Note PDFs are viewed with the Adobe Reader software formerly Acrobat Reader which is installed on IDEXX supplied computers You can download Adobe Reader software for free at http get adobe com reader 3 Click Close to close the Radiology Log dialog box Note If you have made any changes to the log click Save to save your changes then click Close 7 6 Imaging Connections Status Bar The IDEXX Cornerstone Practice Management Software on your computer is connected to other computers inside and outside of your practice The status bar displays the current state of the connections that are related to imaging To view overall connection status The Connections icon is displayed in the lower left of the Image Explorer and Imaging Dashboard windows It shows the
296. r automatically loads the screen for reading Note Io ensure proper radiograph orientation place the animal s head over or near the red arrow on Cy e the cassette For extremities point the animal s toes away from the red arrow i Ca IMPORTANT The oval IDEXX label on the front of your scanner identifies it as either the Model 140 or the Model 140R If you have a Model 140 use only screens that are white on both sides If you Ce have a Model 140R use only screens that are white on one side and black on the other Model 140R cassettes are marked with Kodak or Carestream stickers which display the code GP 2 Figure 17 4 A Kodak GP 2 cassette label 17 4 1 Before Using the Scanner Before using the IDEXX CR 1417 system scanner each day check to ensure that e The USB cable is connected between the computer and the scanner e The scanner is plugged into the power source e The scanner power switch is turned on e The dongle is attached to a USB port on the computer Note The dongle is a device that resembles a USB flash drive and is often green or turquoise in color It contains security software that lets you access the scanner software The dongle should always be attached to a USB port on the computer that is connected to the IDEXX CR 1417 Figure 17 5 A Carestream system scanner GP 2 cassette label e The computer and monitor power switches are turned on e The scanner status LEDs are green Also we recommend th
297. r dialog box to save the settings To select the appropriate gamma Curve 1 Onthe Select DICOM Printer dialog box click Print Test Image Cornerstone sends sample images to the DICOM printer using the configured values for the printer Six images are printed one image for each of the six different gamma correction curves that exist in the Cornerstone software 2 Look at the printed pages and decide which one most closely matches the sample image on the DICOM Print Test Image dialog box 3 Select the option for that printed version e g Image 4 on the dialog box and then click Save Note Be sure to click Save on the Select DICOM Printer dialog box when you have finished all configuration work for this printer 110 To configure DICOM printer elements For some DICOM printers it is possible to configure a number of different elements such as orientation choice of film or paper and display format Display formats require additional configuration covered in the To configure DICOM printer constraint settings procedure 1 On the Select DICOM Printer dialog box click the Configure button to display the Configure DICOM Printer Element dialog box which displays the DICOM elements the default choice for each element and option to set up choices for each element 2 Referring to the DICOM printer s conformance statement type the element name in the Name text box and enter the proper values in the Group and Element text bo
298. r indicates the exposure has been made with a light and or beep 3 When the system is ready to fire again to take another image the LED on the wired trigger box turns from red to green 202 Chapter 19 The IDEXX EquiView Digital Imaging System J Hand Switch Generator Generator Cable Plate Plate Cable i X ray Interface Cable Wired Control Box Trigger Box USB Box If you use the wireless trigger unit Q P S there will be no x ray interface cable aa a Dell Laptop Hand Switch Generator Cable Figure 19 1 Laptop setup Generator Plate 2 E S Rugged Box X ray Interface Cable O Wired T Trigger Box a If you use the wireless trigger unit there will be no x ray interface cable Figure 19 2 Rugged box setup 203 Chapter 19 The IDEXX EquiView Digital Imaging System 19 3 Cleaning and Maintenance 19 3 1 Cleaning Plastic surfaces must be cleaned only with a soap solution If you use other agents AN e g those with a high alcohol content the plastic will be damaged Do not use CAUTION corrosive solvent or abrasive cleaning or polishing agents To clean e Turn off the power and disconnect the power cord before cleaning the device e Make sure that water or other fluids do not get inside the device e Wipe painted parts and aluminum surfaces with a damp cloth and a mild cleaning agent and then wipe with a dry cloth e Wipe chrome parts with a dry cloth only
299. r refer to the IDEXX CR 1417 Digital Imaging System If you have an IDEXX CR 1417 Digital Imaging System Model 140 or 140R use the instructions in chapter 17 The oval IDEXX label on the front of your scanner identifies it as either the Model 140 or the Model 140R 16 1 Background The IDEXX CR 1417 system uses a phosphor screen with energy storage capability as an x ray image receptor The imaging screen is contained inside a cassette Three casette sizes can be used 14x 17 10x 12 and 8 x 10 After exposure the cassette is loaded into the scanner A laser beam which stimulates luminescence proportional to the x ray exposure scans over the screen The luminescence signal is digitized and the exposure data is then passed to digital image processing The screen is then erased with white light Note The only time a screen is out of the cassette is when the IDEXX CR 1417 system scanner automatically loads the screen for scanning The Cornerstone Practice Management system is designed for use with the IDEXX CR 1417 system scanner Knowledge of basic computer functions is required to operate the software and scanner DESS Nyia iainta eee Power Switch Mi a co Ce lt Power Coannector ISR Cannector Figure 16 1 The IDEXX CR 1417 system scanner rear 163 Chapter 16 The IDEXX CR 1417 Digital Imaging System 16 2 The IDEXX CR 1417 System Scanner Your IDEXX repr
300. r when you select an image or series in the Results Detail area the Information area displays the following details e Client Name e Client ID e Patient Name e Patient ID e Species If you select a client only the Client Name and Client ID are displayed 2 2 6 The Button Area Use the following buttons to work with images Many of the same tasks can be selected by right clicking a thumbnail image and selecting the task from the pop up menu Note Most of the buttons are only active when you have one or more images selected When buttons are not active they appear in a lighter color Some buttons are only active when you have the appropriate security access to use that feature 17 Capture Images Import DICOM Import Compare Add to Workspace Create Patent CO DICOM Print j Send DICOM Add to Case Reassign Delete If you have an IDEXX Digital Imaging system click the Capture Images button to capture a patient image Click the Import DICOM button to import an existing image from a DICOM enabled server Click the Import button to use the Image Viewer window to import an image from a file a Scanner or another device Click the Review button to review images series or studies Click the Compare button to review two three or four images side by side When you have only one image selected this becomes the Compare to Original button which lets you compare the current version of an image
301. ra aed ASEEN EEEN ESE 167 16 7 WG Ore Reading an Imaging Fale Ss aace seresecanceancoaneeancasssaasags aossassssduueanades AN EN iN ir kistinin inini 168 16 8 Inserting an IMAGING CASSETHE cccccccccececececeeeceseceseceeeseseesessseeeseseeeseeeeeseeeeeeeeeeeeeeeeesessseesseeseseesaeas 168 16 9 Removing an Imaging Cassete Aen etn en ann ae n ene enn ten eeerenerer erent en FEE KEES ieee a ee ae 169 16 10 Erasing Imaging SCLSCIVS sactaisatna aisatsuiiedieihetinihe ihe in he E REE EEEn ES EErEE Ea aa aa aa aaa a E a E a E ia 169 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System 170 DF AC OG E A T A EEE E A A E E T 170 17 2 The IDEXX COR T417 SCANNET oh ctescieindetscalngelntalucntinindaisndeinuitistdannbadatececatetitecdtide ha ar araa RER e n ain aie 170 te Oey MANOR Oee E 171 To acanner oas LEDS a rr ee re aac eee ENEE E KERERE RSENS ANNA ee Eaa 171 17 4 IDEXX CR 1417 Imaging Cassettes and Screens esssssssssssserreerrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrna 172 17 4 1 Before Using the Scanner sssssssssssssssrererererrrrrrrrrrrrrrtrttttttttttttttttttttttttrrrrrrrrrrrrrrrrrrrrnrnnnnnnna 172 UF Eon o MLE E i E E EE EE A E 173 17 4 3 Removing an Imaging Screen and Cassette from the Scanner ccceeeeeeececeeeeeeeeeetttteeeeeees 173 TAA Erasing Imaging GS i oaaae eaten tenner tic EEE EER IN NN 173 17 4 5 Cleaning and Handling a Cassette ccccscssssssssssssscc
302. rchiving DET AUN S irc gess eer teintledncmdnsmansmduavenaueeeeathceteratbeana hackunonkackanonhevandetnseindubnsntntets 92 8 2 Setting Up Categories for CASS ss siseicszseizicczssccts dansscnsdanasdnsBanansetdeaseaeediasedeenbeb one scseleteeceeiesasatalacaiacalacaienaeds 93 8 3 Seting Up DICOM SSIS eraasi E est ad ONERA EEI EEE ENERE NEEE EEE EEDI EN 93 8 3 1 DICOM Services Configuration at a Glance za ccs2ssessassscncsenanaseaganacaasanaceanasdsaneonsiseestienteianazatasanaiadss 94 832 eino Up Local oerner Daal Sesser EENEN ass KERAKKA 94 8 3 3 Defining Remote Server ConfiQurations cccccccccccccsscccccccccccecececeeessesseeeeeeeseesseseeeeeeeeeseeseeseseesees 96 8 3 4 Delning the Man tfact rer MappiNO sessar a aiaiai asik k a e 97 84 Seting Up Maging EMail eisein EE E E E E iiiaae wm tego aeieteineteiaedeind 99 oo Cin UE EPO DE AUG sese RE 100 8 6 Setting Up Global Settings sntsaostsvesecessceporeseuenadenetanenanetanss dew hctadataiceaddewaccmencutacasncadncauasapopeRegoreherentatandener 100 86 SEWING Up Secure Search MOIS erger nakaa EE ENEA EAE r ETa ETE kaakaa kenaa 101 B7 SINC UO MAN sineren EEEE E EEEE E a ait ive test isis eermearnedinn 101 8 8 ceting Up Koywords Tor NAS Side aac ois cat e EEEa EA taaa EN 103 8 9 Setting Up Multiple Monitors cacicacsesssesavescsess cosunenumanedenatedeiedanadueadanndueaddansmcntncasmentncascesmenereneronepenemneniance 104 8 10 Seung Up WindowLevel Presets s ca scensnersigeneenspeatteensannem
303. re in seconds as a decimal value or use the drop down menu to select a fraction of a second Exposure kVp lype the amount of voltage peak kilovoltage used for this image Level of sedation Select from the drop down menu Use of grid Select the check box if a grid was used Note The Distance text box and the text box that follows with a choice of units of measure are not used by the radiology log but you can fill them out if you want to record this information Click OK to save the information and close the dialog box image Detaits Image Dateeli Ped Saree Li l Eagt i i Fup ania a hyp i H Chapter 7 Other Tools and Tasks Teilrepar ilet Thick fad meki Tnchaeee a F a Enpbiura m4 Espihiwma irna Bed g aun F haaha T ew tfa Figure 7 2 The Technique Details tab on the Image Details dialog box If you are on the Image Viewer window save the image before you exit If you are on the Image Capture window the image and any changes you ve made to the radiology log are saved when you click Done Capture 88 7 5 2 Manually Adding Entries to the Radiology Log Entries are added automatically when you use IDEXX Digital Imaging systems but you can also add entries manually To manually add entries to the radiology log 1 With the patient s record open on the Patient Clipboard in the Patient list area right click the patient name and select Radiology Log
304. re information see 8 3 2 Setting Up Local Server Defaults Type the application entity title for your DICOM server in the Calling AE Title text box Type the maximum protocol data unit length in the Max PDU Length text box This value can be found in the DICOM printer s conformance statement Unless otherwise specified in the DICOM printer s conformance statement accept the defaults for the Timeout text boxes If the DICOM printer supports presentation look up tables select the Supports Presentation LUT check box w Se be DKOM Printer Calan AP Tithe Calling AF Tite Mio bP jargi SRT CTS iiil AHS Fre Gare Witha Timani F Bupi Prgin ia LUT Figure 8 1 The Select DICOM Printer dialog box 109 Chapter 8 Setting Up Basic Imaging Features 10 For many DICOM printers no further setup is required However in some cases you may need to follow one or more of the following procedures e lf your printer does not support presentation lookup tables LUTs use the To select the appropriate gamma Curve procedure e lf you need to configure DICOM printer elements see the To configure DICOM printer elements procedure e If you need to manually configure the way the printer will scale oversize image formats for proper printing see the To configure DICOM printer constraint settings procedure 11 When you have finished all appropriate configuration procedures click Save on the Select DICOM Printe
305. re work flow has not changed Follow the instructions for the default scanner software below To erase the imaging screen with default scanner software 1 Be sure that the scanner is turned on and that the scanner status indicator is steady green 2 Insert the cassette into the scanner See 18 3 1 Loading a Cassette for more information 3 On either the Imaging Dashboard window or the Image Explorer window click Capture Images as if you were beginning the image capture process The Select Client and Patient dialog box appears 4 Type the name or ID of any client or patient in the Search box and click Search The Capture setup window appears No images will be captured for this patient 5 Select any exam type in the Choose Exam Type area and click Next The Image Capture window appears 6 Click Capture Image The scanner interface window appears 7 Click Erase When the erasure process is finished the scanner ejects the cassette 8 Click Exit to close the scanner interface window 9 Click Done Capture to close the Image Capture window No image is saved To erase the imaging screen with newer scanner software A newer version of the scanner software for the IDEXX I Vision CR system is available if you are using the Windows 7 operating system With this upgrade you can erase cassettes with a single click as described below Contact IDEXX Digital Imaging Support at 1 877 433 9948 for more information or to upgrade
306. rmer To achieve grounding reliability in USA installations the equipment must be connected to an equivalent receptacle marked Hospital Only or Hospital Grade Note This grounding reliability statement references a standard that applies in situations where the equipment is located within a patient vicinity area of 6 feet 1 83 meters If the equipment is used outside of this 6 foot patient vicinity and connected to a non hospital grade receptacle it will function but it will not provide grounding reliability at the level referenced in the standard 191 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 7 Electrical Information 18 7 1 Electrical Hazards Caution observe the following e Do not remove or open system covers or plugs Internal circuits use high voltage CAUTION capable of causing serious injury e Fuses blown within 36 hours of being replaced by a qualified technician may indicate malfunctioning electrical circuits within the system Have the system checked by qualified service personnel Do not attempt to replace any fuse e Fluids that seep into the active circuit components of the system may cause short circuits that can result in electrical fires Therefore do not place any liquid or food on any part of the system 18 7 2 Electromagnetic Emissions Immunity Electromagnetic compatibility precautions gt Medical electrical equipment requires special precautions regarding electromagne
307. rrrrrrrrrrrrrrrn 228 Chapter 21 The IDEXX DR Relay BOX ccccsscsesseeeseeeeeeeeseeeseeeneeenseeeaeeonseoeaeeeaseoeaeeenseoneens 229 Ak Hawas LES CHDI 9 ene err eee tr eee ane nee See Nee Ree Oe ee Seen rar nnn ree een ee re eer eer eee cee eee Seer 229 21 2 Background on Generator Interfaces ccccccccsseesseseecesscssecceeeseeacaaeeeceeeeeseeeeeseseeeseseeeseeeseeeeeeees 229 21 3 Using the IDEXX DR Relay BOX Qeemerene ara mea ent me enn eer See eure eer tre nr er Ernan erento eer a eee eee eee 229 21 3 1 Resetting If You Release the Switch Before EXpOSINg ccccccccccccececeeeeeeeesseseeseseeesesssesseseeens 231 AE WPOMIONSS GO a aaa int EE E A E S TT deuenetisioneustueet auazaesh cuadteter 231 21 5 Technical Cleaning and Safety Information scscnscs222nceasesadenapesagensatainndeinedanndeendntreacatasataeatacasacamsannaxceananeacs 232 ESEE RO ONS E E SE E E E AES 232 21 5 2 Relay Box Power Source Caution sssessssssssesessssssssrrerrrrrrrttttttttttrrrrtrtrrrtrrrtrrrrrrrrrrrrrrrrrrrrnna 232 21 6 Replacing the IDEXX DOR Relay BOX ei tues otis nee aa ane E OA E p E ER aaia anaa 200 Section 3 IMAGING Integration sess ces cecteewecsiees ces ssecees ete enwvesnseswweadwoneessenterewnsvedeeastensssseevienesss 235 Chapter 22 Using IDEXX SmartLink Digital Imaging and Modality Worklist Integration 235 Laas ie O c E eee tet Rem E E E EEEE ete toe none oman E 235 22 1 MDEXX Smaak Digtal MAg sessies
308. rsa s a p a AAA EEA 235 22 1 2 Integration with Third party Imaging Systems eeeessesseeeeeeeeeenrrrrrerrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrns 235 22 Vad Prepanng for Integrati n serseri t eC EEEE Nr a a a a TEE iii 238 22 2 o6t p and Work Flow Enhancements s serret irisicsv ase a as i Api EERTE E Fir FEEFEE KERE EREEREER 239 22 2 1 Transitioning from Earlier Versions of IDEXX SmartLink Digital Imaging s 239 22 3 Imaging Integration Setup Examples a 1 2es 22s22c2c2 ceanaassassnqtousunnqunccenenenenenssenanareeataaaranacnaacauniezenenerenezert 240 22 3 1 Basic example Using a Miscellaneous item to bill for a set Of images eee 240 22 3 2 Advanced example Using service items and smart Codes cc cccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaaaees 243 22 3 3 Additional Invoice Item Possibilities ccccccsescssssessssceeseeseceeesssessenseuesntseesseessseeeresseeeeeeseenaueees 244 22 A Seung Up Imaging WIG OTAIOM eessen sr p en EANNAN E EEEE r a tirba 245 22 4 1 Activating Imaging Integration vase ii heitetecndinansnendueds tasonedndwawieddidexbunvis yubeaues cele verdiarPcerccshdnanduindonntes 245 22 4 2 Setting Up Imaging Integration Defaults nn nn nnn EE EE II LEI EEE EEE LE nnn 245 22 4 3 Setting Up Invoice Items to Initiate Image Request Special ACtIONS ceee cere 246 2A Jono imaging Neg ANN esea asaan AEEA 248 22 5 1 Creating an Image Request When entering charges Special Action Method 248
309. s is displayed Rectangle Click and drag to draw a box around part of an image 44 a a PS Chapter 5 Reviewing Images Ruler Click and drag to draw specific measurements and lines on an image The units of measure line attributes font and color can be changed with the Pointer tool See the Pointer tool instructions above WARNING The Ruler tool is accurate only if the system has been calibrated for this type of image or if this image has been calibrated with the Calibration tool lf the system and or image is not yet calibrated when you click the Ruler tool a dialog box appears in order to begin the calibration process See the Calibration tool instructions for more details Straight Line Click and drag to draw straight lines on an image Text Click and drag to create a text box on an image then type text in the box The font color and size of text can be changed with the Pointer tool See the Pointer tool instructions above TPLO For instructions on using the TPLO Tibial Plateau Leveling Osteotomy tool for surgical planning see 5 2 1 The TPLO Tool This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software Norberg Angle For instructions on using the Norberg angle tool for measuring hip dysplasia see 5 2 2 The Norberg Angle Tool This tool
310. s to the files that will be exported click Apply Annotations and or Apply Overlays 7 Click Export The files are copied to the selected disc 35 Chapter 4 Cases and Telemedicine Image file names and formats Image file names have the following format PatientName OwnerLastName_ ImageTitle YYMMDD_PG xxx where YYMMDD is the date the image was captured PG is the page number of the image and xxx is the type of file Text file names and formats Text file names have the following format PatientName OwnerLastName_ CaseTitle YYMMDD txt The text files are described in section 4 6 Text File Contents To send a case via DICOM 1 On the Case Detail window if the Case Actions pane is not open click Expand gt gt 2 Click the DICOM tab 3 Inthe Remote Servers list select the server or servers to which you want to send the case 4 Doone of the following e To send this case to the selected server s select Send DICOM e To save this case to send later click Save and Exit 4 6 Text File Contents A text file is sent with the case whenever you email a case export a case to a CD DVD or create a patient CD with a case This text file contains e Information about the case Figure 4 6 The Case Actions pane showing the DICOM tab e Patient information e Client information e Information about the images in the case e Contact information for your practice On a patient CD this text file is included on the
311. scriptions warning signs e Damage or breaks in any cables or connections e Water leaks unusual noise 219 Chapter 20 The IDEXX I Vision DR System If functional defects or other deviations from normal operating conditions occur the operator must turn off the equipment and inform IDEXX Digital Imaging Support The equipment can be used again only after repair Operation with defective components can lead to an increased safety risk To perform the detector plate self test 1 Turn on the power to the IDEXX I Vision DR System The detector initiates a series of self tests 2 Observe the LED on the black box e ifthe LED is green the detector has passed the self tests After the 30 minute warm up period use the system as normal e lf the LED is blinking orange red an error occurred in one of the self tests Contact IDEXX customer support before using the system In the U S or Canada call 1 877 433 9948 20 5 Servicing servicing of the IDEXX I Vision DR System may be carried out only by personnel authorized by IDEXX The correct setting of the electromechanical and electronic components affects system function image quality electrical safety and the radiation exposure of patients and medical personnel IDEXX recommends that you e Carry out the daily operator inspections as indicated in the preceding section on a regular basis e Have the device serviced at least once a year by IDEXX Devices used very often may need to be
312. serviced more frequently A service contract with IDEXX helps you preserve the value and safety of your device All necessary servicing including safety inspections for preventive hazard protection is performed at regular intervals IDEXX coordinates service intervals with you depending on the service level you elect Please refer to our extended maintenance agreement terms for a complete description Defective components that influence the device s safety must be replaced by original spare parts Note There are no user serviceable components within the IDEXX I Vision DR System All service is subject to the terms of the IDEXX Warranty or Maintenance and Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 220 Chapter 20 The IDEXX I Vision DR System 20 6 Disposal The detector panel and its control box contain elements that may be considered hazardous or special waste at the end of their useful service life For disposal or recycling information contact your local authorities 20 7 Technical Specifications Detector type Direct conversion TFT amorphous selenium Detecting area 14 x 17 856 mm x 427 mm Matrix resolution 2560 x 3072 7 8 M Pixel size 139 um x 139 um Bit depth 14 bits Individual image size Storage 15 MB standard monitor Color 1600 x 1200 display Optional monitor 21 3 2 MP grayscale can upgrade to 3 MP
313. sette unlocks from the scanner and can be removed and reused O S S E S In the event that the screen and cassette do not eject turn off the scanner and then turn it back on COE This ejects the plate and cassette If this does not work unlock the Er cassette manually by pulling the screw beneath the slot 16 10 Erasing Imaging Screens o il o Wy gt Each imaging screen is a ma automatically erased by the IDEXX CR 1417 system scanner after it Pull screw to unlock cassette reads the screen Although the imaging screen is encased in a protective cassette over time the screen absorbs radiation that exists naturally in the surrounding atmosphere If an imaging cassette has been sitting out for any length of time be sure to erase it before using it to acquire images Figure 16 5 The front of the IDEXX CR 1417 system scanner showing the screw used to unlock the imaging cassette To erase an imaging plate 1 Be sure that the scanner is turned on and that the System LED is green 2 Insert the cassette into the scanner See 16 8 Inserting an Imaging Cassette for more information 3 Inthe Control Panel click Erase 169 Chapter 17 Ine IDEXX CR 1417 Model 140 or 140R Digital Imaging system IMPORTANT The instructions in this chapter refer to the IDEXX CR 1417 Digital Imaging System Model 140 or 140R If you have an IDEXX CR 1417 syst
314. shots have not been selected for the item then an Exam Description is required Repeat steps 3 4 as needed for each invoice item listed in the image requests grid When you are finished click OK 22 5 2 Creating an Image Request from the Patient Clipboard Manual Method If desired you can create an image request using the Imaging gt Image Request right click menu option on the Patient Clipboard Note In order to create an image request using the manual method SmartLink Digital Imaging must be activated To create an image request from the Patient Clipboard basic steps 1 With the patient s record open on the Patient Clipboard in the Patient list area right click the patient s name and select Imaging gt Image Request anr The New Image Request dialog box appears Pastin eH Dedy Lami Logra Lee Note You can also access the New Image Request dialog box by clicking New on the Image Requests and Results window In the Staff ID text box enter the ID of the staff member responsible for the image requests by typing the ID or selecting the staff from the drop down list In the image request grid s next available Item ID text box enter an item ID by either typing the ID or pressing F2 to search for and select the item from the Invoice Item List Figure 22 5 The New Image Request dialog box when manually creating request Note To delete an item from the grid click in the item s Item ID text box and press CTRL D
315. sic information about the age patient or client selected The buttons in the Button area launch activities related to the image patient or client Figure 2 1 The parts of the Image Explorer 2 2 1 The Search Area Quick Search Tab To search for a patient or client by using the Quick Search tab 1 Type information in one or more text boxes in the search area e Client and Patient Type client first and last name patient name and or client or patient IDs e Date Select a time period from the drop down list e Species Select a species from the drop down list 14 Chapter 2 Program Basics 2 Click Search Results are displayed in the Summary List area and the Results Detail area Note If your search criteria will provide a very large number of results and run a long time a dialog box warns you and gives you the option to stop the search 3 If you want to clear the search text boxes and start over click Clear This also clears all the results in the Summary List area and the Results Detail area 2 2 2 The Search Area Advanced Search Tab To search for a patient or client by using the Advanced Search tab 1 Type information in one or more text boxes in the search area Client ID Type the ID or press F2 and use Quick Search Advanced Search the Client List dialog box to choose the client avers e El nee Client First Name and Client Last Name eee ees Reser bein ceca teat
316. sing the IDEXX I Vision Mobile Application 23 2 2 Sending Images To email images 1 Locate a patient on the Patient List screen 2 Tap the patient _ Note The same button is available on the Viewer screen 3 On Patient Summary select radiograph s and tap 4 Select Image s Series or Study 5 Type To From addresses and message and tap Send To send images via DICOM 1 Locate a patient on the Patient List screen 2 lap the patient 3 On Patient Summary select radiograph s and tap a Note The same button is available on the Viewer screen 4 Select Image s Series or Study 5 Select DICOM server for recipient and tap Send To send images to a telemedicine provider 1 Locate a patient on the Patient List screen 2 lap the patient t Note The same button is available on the Viewer screen 3 On Patient Summary select radiograph s and tap Select Image s Series or Study Select DICOM server for recipient and tap Send 23 2 3 Requesting Radiographs To request images 1 Locate a patient on the Patient List screen 2 lap the patient 3 On the Patient Summary screen tap gt 258 Chapter 23 Using the IDEXX I Vision Mobile Application On the Select Invoice Item dialog box select an invoice item and tap Select The Request Screen appears Any views assigned to this invoice item are appear under Shots requested To add or remove views see instructions in 23 4 5 Request
317. so be prompted to archive images if your Images folder nears its storage capacity IMPORTANT It is important to store archived images in a safe location If archived data is lost or damaged images cannot be recovered To set up image archive and alerts 1 On the Controls menu select Defaults gt Imaging 2 Onthe left side of the Imaging Configuration window select Archive 3 To activate archive alerts select the Enable Archive Alerts check box 4 Inthe Alert Frequency area select when you want an alert to appear e To be alerted when a certain number of images has accumulated click the option button to the left of the Images box and type the number of images e To be alerted when certain number of days has occurred click the option button to the left of the Days box and type the number of days When the value of images or days is reached a message box appears indicating that it is time to archive your images 5 Inthe Archive Location text box specify the location where you would like archived files to be stored 6 Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window Chapter 8 Setting Up Basic Imaging Features 8 2 Setting Up Categories for Cases Category names are available from a drop down list when you create or update a case allowing you to choose categories to assign to the case Cases are created so that you can send images and accompanying informati
318. srsiiiiiiniioiei aa it tits sawn ya veblivi ya Debi eNEAN Eiaa ESR 82 06 Overlays and DICOM s serssoireru einan anae E NENEN REKEREKE REER NA ER REA PERERA E EEE EAEAN EENEN 82 OFF OOUIG eG POS S aae EEEE EE EA SEESE 83 Chapter 7 Other Tools and Tasks ccccsscssseeeseeeseeeseeenseeeseeneeeseeeeneeeaeeoeseeeaeeonaeneaeeonseosaeeoas 84 A NANCY MAJO aspispa Eaei de ea NE EEE E AE ERa iai diania TN 84 TVs OMI an Mage SUY sedrer E ANNANN 85 7 3 Deleting Images or Studies ccccccsssssssssssessnnneeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeseeeeeeeeeeeeeeeeeeeeeseeseeseseseenestenegs 85 Ta upaaing animadas RoCo essa ea natn ine EAE RA or nT ene eee een eee eee 85 7 5 Using ihe Radiology OC a cia ictesaaeatatgincsietecndnindaipantoanannadestsanecacutdutanatde EE R AAA R E ARRA 86 7 5 1 Recording and Editing Radiology Log Information eessssssssssrrrrirrrrrrrrrnnrerrerrrrrrrrrrrrrrrrerreent 86 7 5 2 Manually Adding Entries to the Radiology LOO sisicncvsssisteadswsatscndecedenaeeteltnansbsiniveansseaguansndedadededededcsnde 89 7 5 3 Viewing Printing Emailing and Exporting the Radiology LOG sicccscscccvsssvsacndnivessstnseesavneasdoscectecmane 89 7 6 Imaging Connections Status Baf seeseseeeusnnnnennrnnnrnrrrrrrrrrrrrrrrrrrrrrrrrrissssssssssssssssssssrereenrerrrrererererrrrrrene 90 Chapter 8 Setting Up Basic Imaging Features c ccccsseeeeeeeeneeeeeeeeseeeseeeneeeeseeeaeeeeeeeeseneaes 92 8 1 Setting Up Image A
319. ssfully tested Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window 108 8 12 Setting Up a DICOM Printer To select and configure a printer for DICOM printing you will need to consult the conformance statement and other documentation for your DICOM printer If you have questions contact the manufacturer of your DICOM printer or contact IDEXX Digital Imaging Support at 1 877 433 9948 Chapter 8 Setting Up Basic Imaging Features Note When you set up your DICOM printer with Cornerstone for the first time you need to call IDEXX Digital Imaging Support at 1 877 433 9948 to activate the feature To configure a DICOM printer Choose Activities gt Imaging gt DICOM Printer gt DICOM Printer gt Select DICOM Printer from 1 the menu bar to access the Select DICOM Printer dialog box Click New to create a new record Note If you have already configured a DICOM printer select the desired printer from the Printer drop down list Enter the name of the DICOM printer in the Name text box Enter the IP address for the printer in the Host text box and the printer s port number in the Port text box Type the called application entity title in the Called AE Title text box This information can be found in the DICOM printer s conformance statement Note This is the local server AE title shown on the Imaging Configuration window when Local Server is selected on the left For mo
320. start or cancel image sending see 6 4 Using the DICOM Queue 25 Chapter 6 Distributing Images and Using DICOM 6 4 Using the DICOM Queue The outbound DICOM queue shows the progress of image sending and details about images that have been sent This window allows you to pause restart or cancel image sending The inbound DICOM queue contains information about images that are being received or have been received by Cornerstone This window allows you to pause or cancel image receipt To view the outbound or inbound DICOM queue gt Select Activities gt Imaging gt DICOM Queue from the menu bar The DICOM Queue window appears Do one of the following e To view the outbound DICOM queue select the Outbound tab e To view the inbound DICOM queue select the Inbound tab 6 4 1 About the Outbound DICOM Queue The outbound DICOM queue displays a table listing images that have been sent by the system are in the process of being sent or are waiting to be sent The table organizes the images by series and study Click the sign for a study to see the series within it and click the sign for a series to view the images within it The following information is displayed for each image e Names of the patient and owner client e Date that the image was captured e Names of the study series and image e Destination to which the image is being sent e Status of the sending process e Priority of the image Each image has a sta
321. t 20 2 Cleaning and Maintenance 20 2 1 Cleaning Plastic surfaces must be cleaned only with a soap solution If you use other agents AN e g those with a high alcohol content the plastic will be damaged Do not use CAUTION corrosive solvent or abrasive cleaning or polishing agents To clean e Turn off the power and disconnect the power cord before cleaning the device e Make sure that water or other fluids do not get inside the device e Wipe painted parts and aluminum surfaces with a damp cloth and a mild cleaning agent and then wipe with a dry cloth e Wipe chrome parts with a dry cloth only 20 2 2 Disinfecting The IDEXX I Vision DR System must not be subject to a bath disinfection sterilized in an autoclave or put into another device for sterilization The IDEXX l Vision DR CAUTION System can be wiped with a disinfectant The method of disinfection must correspond to the applicable legal regulations and guidelines on disinfecting and explosion protection Do not use corrosive solvent or gaseous disinfectants If you 217 Chapter 20 The IDEXX I Vision DR System use disinfectants that form an explosive gas mixture they must evaporate completely before you turn on the device To disinfect e Turn off the power before disinfecting the device e Wipe the IDEXX I Vision DR System with disinfectant e All parts of the device including accessories and connecting cables must be given only a wiping disinfection
322. t by yourself Always seek assistance from another person Lifting equipment that is too heavy may result in serious injury and or damage to equipment 18 12 Health and Safety Compliance 18 12 1 Safety USA Canada International European Union UL 60601 1 2003 Medical Electrical Equipment CAN CSA 22 2 No 601 1 M90 Medical Electrical Equipment R2001 CAN CSA 22 2 No 601 181 94 Supplement No 1 94 to Medical Electrical Equipment R1999 CAN CSA 22 2 No 601 1B 90 Amendment 2 to Medical Electrical Equipment R2002 IEC 60601 1 1988 A1 1991 A2 1995 Medical Electrical Equipment IEC 60825 1 1993 A1 1997 A2 2001 Safety of Laser Products EN 60601 1 1 2001 Medical Electrical Equipment EN 60601 1 1990 A1 1993 A2 1995 A13 1996 Medical Electrical Equipment EN 60825 1 1994 A1 1997 A2 2001 Safety of Laser Products 198 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 12 2 IEC Standards for Electromagnetic Compatibility and Laser Safety IEC 60601 1 2 2005 Medical Electrical Equipment Electromagnetic Compatibility Requirements amp Tests IEC 60825 1 2 2001 Safety of Laser Products Part 1 Equipment Classification Requirements and User s Guide 18 12 3 CE Conformity This product conforms to the requirements of council directive 93 42 EEC The Scanner is a Class medical device The Scanner bears the following mark of conformity 18 12 4 IEC Symbols Used
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324. tch the submission to the patient To assign a telemedicine submission created outside of the Cornerstone 1 Onthe menu bar select Activities gt Imaging gt Telemedicine Queue The Telemedicine Queue window appears and displays all telemedicine submissions that are not assigned to a patient 2 To view a submission select it in the table and click View Case A Web browser opens and displays the information on the telemedicine provider s Web site 3 To assign this submission to a patient click Assign The Select Client and Patient dialog box appears 39 Chapter 4 Cases and Telemedicine Type the patient s name or ID in the text box and click Search select the patient in the table and click Select A case containing this submission is created for this patient Submission status is displayed on the Image Explorer window 6 To view status information or reports on the Case Detail window click the status icon 4 9 Submitting Remote Consult Requests to a Radiologist or Telemedicine Service The Remote Consult feature connects you to the Web page of a independent radiologist or telemedicine service so that you can provide information about radiographs you are submitting or access information about radiographs you have already submitted This feature is useful if you send images or a case to a telemedicine provider without using the SmartLink technology for telemedicine or if you send images or a case separately using another feature
325. ted Properly Orientation rules also called hanging rules are incorporated into the programming for each exam type but you can still rotate or flip an image as needed Note After an image is rotated a marker appears that shows the number of degrees clockwise the image has been rotated from the orientation in which it was captured An X marker appears after the image has been flipped horizontally These markers are always displayed with the image in the Cornerstone software and cannot be hidden To use the Flip Horizontal tool gt Click the Flip Horizontal tool to flip the image horizontally To use the Rotate tool gt Click the Rotate Clockwise too as to rotate the image 90 degrees clockwise 12 1 2 Does the Image Look Right A number of tools can help you adjust the appearance of an image The most important image adjustment is window and level also called contrast and brightness When enhancing the image you may want to use the Magnify tool and the Fit to Window tool to see all or part of the image more clearly The Invert tool may be useful in some circumstances Note When viewing radiographic images it is essential to use a properly calibrated monitor For more information see the article at idexx com calibrate 12 1 3 Window Level Contrast and Brightness When Cornerstone processes the image It reviews the context of the image and uses parameters defined by exam type to create the default look of the image
326. tersiataneseaseeceancaeecqee ASAS ESATI 13 2e POO UIE TN Ae Explora aende ER OEE DA DEET aa Taa ea E SEE REKEREKE 13 221 The Search Area Quick Search TAD snvisicscaonccimesenadicniaattataceqisten eicadantdadetatdetaudstanisbacartactistiwenivenenonsananias 14 222 Ihe Search Area Advanced Search TaD sn cuouinensnusierssnendntivatanasinstesesvcthumekensiacananameaxeundoerseegomaal 15 AA Ne umay ST AE eaer rede r E EEEE E iiinn EER E 16 22A The Results Detail Alea s eic tere erecta ciate inn iii EAE NAREDNE EEE a isara a NE EAEk Eesen taK 16 Bo TNE TINTON AE ets cre te ces See er AOA E i ENAA 17 LEEDO A ea E EA EENE E E E EAEE E E EEN 17 2 3 ADo L Image Senes and SLAY sins ok revs ose sans save nemcnentminnenenceunaidnomeannararenncindamtinlasiddahnaradadadabawssereagva tere bunds 19 BM NN LOIS NEE ep clacton eluetoneet A AEEA A EE E I E E duces EN 19 PARA EE j E PE EEATT E TEA A EA AE A EEEE AAE AAT ETEN 19 Peg DENY PEA A NOAE A A A AAEE T E 19 2 3 4 How Images Series and Studies Are Named esssssssssssssrrrriirrrirrrirrrerssrrrrrrrrrrrrrrrrreeeererrrrrrrr 20 2A COmNMON Merac ONS esenea ere een EOE PENE EEEE ae mn ee eee ree 20 Chapter 3 Importing Images via DICOM ccccceecseeeeeeeeeeeeeeseeeeeneseesoeesenesonesensoeeseeenonens 22 3 1 Importing neta DICOM MAGS S ss sates catacccrsaracate ected cd herltettsteelitladiettaaearbahdstata Sid ukheonceaoplehowenaeehinndeeed 22 3 2 Using DICOM Query and Retrieve to I
327. the connection with the system vendor or manufacturer We maintain a list of systems that have been validated by IDEXX as capable of integrating with Cornerstone See idexx com validatedsystems for the list of validated systems There is a one time fee for setting up the integration between Cornerstone and each type of validated system Contact your IDEXX Cornerstone sales representative at 1 800 283 8386 For more information As with any integration between Cornerstone and non IDEXX systems the level of integration depends on the capabilities of the non IDEXX system The table on the next page gives a general overview of the work flow you will experience at different levels of integration DICOM Imaging or the Diagnostic Imaging module purchased with previous versions of Cornerstone is a prerequisite to using Modality Worklist Integration Note For information on purchasing IDEXX DICOM Imaging or Modality Worklist Integration contact your IDEXX Cornerstone sales representative at 1 800 283 8386 If you have an IDEXX Digital Imaging system and already have IDEXX SmartLink Digital Imaging you do not need to purchase any additional software 236 Chapter 22 Using IDEXX SmartLink Digital imaging and Modality Worklist Integration For all integration levels e The system is DICOM compliant e The system supports the modality worklist MWL feature of DICOM either on its own or with additional software LF For basic integration For parti
328. the port number for the server in the Port Number text box 94 10 11 12 13 Chapter 8 Setting Up Basic Imaging Features In the Transfer Queue Watch Interval text box specify in seconds how long the DICOM server should wait between checking the DICOM Queue for images to be sent Do not change anything in the C Find Options area These advanced features should be changed only in consultation with IDEXX Digital Imaging Support specify the maximum number of external devices that can access the local DICOM server for requests at one time in the Maximum Number of Clients text box specify the number of seconds that can elapse before the DICOM message service element DIMSE times out in the DIMSE Timeout text box After the local DICOM server has opened a line of communication with an external device it expects to receive a request from that device This text box defines how many seconds can pass before the local server times out For example if this text box is set to 45 seconds and the local server does not receive a request from the external device within that time the line is closed and the association between the two devices ends In the Socket Close Delay text box enter the amount of time in milliseconds that can pass before the socket between the local device and an external device closes after a line of communication has ended A socket is an endpoint for communication between two devices When a socket is ope
329. the terms of the IDEXX Warranty or Maintenance and IDEXX Support Agreement and must be performed by an authorized IDEXX service technician For service within the United States or Canada call 1 877 433 9948 176 Chapter 17 The IDEXX CR 1417 Model 140 or 140R Digital Imaging System 17 6 Scanner Roller Cleaning The roller cleaning process enables you to clean the rollers that feed the screen from the cassette into the scanner Clean the rollers monthly to remove dust and small particles The cleaning process requires the following e A cleaning tray e Acleaning plate with adhesive strips covered with protective paper and a protective envelope To order new cleaning plates contact IDEXX Digital Imaging Support In the U S or Canada call 1 877 433 9948 Note The cleaning process is different for the Model 140 than it is for the Model 140R Be sure to follow the proper instructions To clean the rollers for the Model 140R 1 Remove any cassettes and screens from the scanner 2 In Cornerstone use the menu at the top of the window to select Controls gt Defaults gt Imaging and then select Imaging in the navigation menu on the left The Imaging Configuration window appears Figure 17 11 Removing the protective paper Click Scanner Configuration Settings The Password dialog box appears Type user in the User name text box and idexx123 in the Password text box then click Login After a pause of a few seconds the User window
330. this entry manually you may be able to edit additional text boxes Use the Patient ID and Client ID text boxes if you want to change the patient or client Click Save To record or edit log information for multiple patients 1 A On the Menu Bar select Activities gt Imaging gt Radiology Log To select log entries to display fill in the appropriate search text boxes and click Search For example you might want to use the Start Date and End Date text boxes to select all the log entries during a certain period of time For instructions on recording and editing log information see steps 2 and 3 in To record or edit log information for a patient above 87 To record or edit log information for an image 1 Do one of the following On the Image Viewer window click Edit Image Details i On the Image Capture window after you have captured an image and the buttons at the top of the screen have turned red click Image Information l 2 Click the Technique Details tab Fill in any of the following text boxes for which you want to record information Thickness lype the thickness of the body part being imaged Exposure mAs lype the amount of x ray exposure in milllampere seconds mAs This is calculated automatically if you enter values in the Exposure mA and Exposure time sec text boxes Exposure mA lype the amount of current in milliamperes mA Exposure time sec lype the duration of the exposu
331. tic compatibility EMC Medical equipment must be installed and put into service according to the EMC information provided in the following documentation Communications Equipment gt Portable and mobile radio frequency RF communications equipment can affect medical electrical equipment EMC performance Replacement of Cables Accessories or Transducers gt The use of cables accessories or transducers other than those specified below with the exception of transducers or cables sold by the manufacturer of the equipment as replacement parts for internal components may result in increased emissions or decreased immunity of the medical equipment Other Equipment gt The scanner should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the scanner should be observed to verify normal operation in the configuration in which it will be used 192 Chapter 18 The IDEXX I Vision CR Digital Imaging System Cable accessory and transducer information for the scanner Port Type Port Description From To Cable Type Possible User Action Power AC Power Scanner AC Mains Unshielded 3 meters Signal Scanner PC Shielded 3 meters Guidance and manufacturer s declaration electromagnetic emissions The scanner is intended for use in the electromagnetic environment specified below The customer or the user of the scanner should assure that it is used in such an environment Emissions test C
332. time by right clicking any line or text in the ee and selecting Calculate VHS 8 Save the annotation by clicking Save and selecting Save from the drop down menu To change VHS tool settings 1 After you have placed the VHS measurement lines on a radiograph click on any of the VHS lines to select the annotation then right click on any of the lines The VHS Annotation Settings dialog box appears 2 On the VHS tab change the following as needed e To override the calculation type a VHS value in the VHS text box This value is displayed on the image Note To restore the calculated value right click one of the VHS tool lines and select Calculate e Type a number in the No of Vertebrae text box to set the number of vertebrae you will measure with the vertebrae line The software uses the vertebrae line to calculate average vertebra width e Use the options in the Font and Text Color areas to change how the VHS value is displayed 3 To change the way the measurement lines are displayed click the tab for the Vertebrae Line X Axis vertical axis or Y Axis short axis and do the following e Change the color and opacity of the line in the Outline Color area e Select a line pattern e g solid or dashed in the Line Pattern drop down menu e Change the line thickness in the Size text box 5 3 The Thumbnail Pane 5 3 1 Moving Resizing or Hiding the Thumbnail Pane You can move the Thumbnail pane so that it is display
333. tion click Refresh e To change the status of images in the queue use the buttons on the right side of the DICOM Queue window o Select an active or pending image and click Pause to put that image on hold The image will not be sent unless you restart it o Select an active pending or on hold image and click Cancel to cancel the sending of that image The image will not be sent o Select an on hold failed or completed image and click Resend to change that image s status back to Pending The image will be sent when it reaches the top of the queue o Select Resend Failed to change all the failed images to a status of pending These images will be sent when they reach the top of the queue o Select any image and click Remove to remove that image from the list o Select Clear Completed to remove all the canceled and completed images from the list Note To save time you may want to use these buttons on a whole study or series at the same time When you click a button for a study or series the button action is applied to all the images with the appropriate statuses For example if you have a study with one image that is on hold one that is completed and one that is pending and you select the series and then click Pause the pending image will be put on hold and the other two images will be unchanged es Chapter 6 Distributing Images and Using DICOM e Change the priority of an image series by selecting an image in that series cl
334. tion about using IDEXX SmartLink Digital Imaging with Cornerstone see Chapter 22 Using IDEXX SmartLink Digital Imaging and Modality Worklist Integration Figure 23 1 The Patient List screen fee orem 1 Ja o Tepr p1 Yema F ahe 5 Diiia Pe 260 To search for images q Type name or ID for patient or client then tap Q To open the Patient Summary screen Tap anywhere in patient bar to open Patient Summary for that patient Alerts Alerts show activity in the last 24 hours Radiograph request pending Telemedicine request pending New radiograph s DO 0 GO New telemedicine report s Toolbar buttons Chapter 23 Using the IDEXX l Vision Mobile Application Clear search Show list of patients with alerts Tap patient row to open Patient Summary Log off ow JE Display help open To display reports on the Dolphin Browser application save the PDF then tap to 261 Chapter 23 Using the IDEXX I Vision Mobile Application 23 4 2 Patient Summary This screen shows the images for a patient It s the jumping off point for everything you can do in the mobile application Toolbar buttons Pe ee a Back to Patient List Pe ache m To open and close series rows of images j i A i Blt bids RH Open image series Close image series To begin the image sending process Tap one or more thumbnails then tap Eel
335. to create a patient CD email the case export the case or send the case via DICOM From this pane you can also submit a case to a telemedicine provider see case status details and view the telemedicine provider s report Figure 4 1 The Case Detail window showing the Case Information pane 24 The panes roll up to a small area when they are closed To open a pane click the pane title or anywhere in the bar between the title and the Expand gt gt on the right side of the pane header To close a pane open one of the other panes 4 2 Creating Cases To create a case from the Image Explorer 1 2 3 A 2 Select one or more images series or studies on the Image Explorer window Click New Case or right click and select New Case The Select Images dialog box appears Do the following e Select Image to create a case with only the images you have selected e Select Series to create a case with the series to which the selected images belong e Select Study to create a case with the study to which the selected images belong Note For more information about image series and study see 2 3 About Image Series and Study Click Select The Case Detail window appears If the Case Information pane is not open click Expand gt gt In the Case Title text box tyoe a name for this case In the Staff User drop down list select the staff member or Cornerstone software user associated with this case In the
336. tool Remove the screen SS SSS SS 1 Slide the edge of the extraction tool provided with your scanner over the back edge of the O E cassette Pull the tool down until it enters the square slots in the back aagi of the cassette 2 Hold the cassette horizontally Locate the cassette slider in the extraction tool s central opening 3 Push the slider towards the edge of the cassette until the edge of the screen is visible Figure 18 8 Installing the extraction Carefully pull the screen out and place it on a clean dust free surface tool onto the back of the cassette Note Observe which side of the screen faces the top side toward the x ray tube This is the side to be cleaned 7 Tube side Clean the screen 1 Fold a nonabrasive lint free cloth and dampen with a small amount of cleaner or distilled water Do not pour the cleaner directly onto the screen Excessive amounts of cleaner may damage the screen _______ Extraction tool 2 Wipe the screen gently and thoroughly one section at a time Fold the cloth to expose a fresh area for each section of the screen Figure 18 9 The edge of the screen 3 If necessary for the removal of persistent dirt apply pressure while cleaning STEN a edeset Return the screen to the cassette 1 After cleaning wipe the screen thoroughly dry with a clean dry non abrasive lint free cloth or wipe to remove residual cleaner Do not leave the screen to air dry CAUTI
337. trieve to Import Images from Remote Servers Note You may need to use the scroll bar at the bottom of the Remote Servers table to bring the Support Query Retrieve text box into view Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window To edit the configuration for a remote external server 1 a On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration dialog box select DICOM Services and then select Remote Servers 96 Chapter 8 Setting Up Basic Imaging Features In the Remote Servers drop down list select the server you want to edit and edit the server information as needed Click Save to save and close the Imaging Configuration window or click Apply to save without closing the window To test the remote external server 1 2 On the Controls menu select Defaults gt Imaging On the left side of the Imaging Configuration window select DICOM Services and then select Remote Servers In the Remote Servers table select the server you want to test Click the Test Server button on the right of the window The DICOM Services program pings the selected server e lf the test is successful the Test Successful message appears Click OK e lf the test fails the message Unable to echo server 4 4 appears equals the IP address of the server that was pinged Click OK to continue or c
338. ts the series and study information created by those devices o Ifyou import images from a non DICOM source Cornerstone names the study for today s date and asks you to give the series a title Note For more information about image series and study see 2 3 About Image Series and Study 116 Chapter 10 Capturing Images 10 1 Capture Process Overview The process of capturing an image with the IDEXX Cornerstone Practice Management System is discussed in these three chapters e Chapter 10 Capturing Images covers the basic steps in the capture process e Chapter 11 Image Coach and Other Tools contains information on additional features that are available during the capture process and discusses ways to add images to Cornerstone by importing them or using a scanner e Chapter 12 Checking and Approving Images discusses how to make sure you are capturing the highest quality images The first step in the image capture process is to choose the radiographs exam types that you want to capture The following sections explain the different ways to start the capture process and choose the radiographs The methods vary depending on whether you use IDEXX SmartLink Digital Imaging and depending on your installation configuration 10 2 Starting the Capture Process Using a SmartLink Capture Request If you have IDEXX SmartLink Digital Imaging you can create a request for digital images electronically anywh
339. tus listed in the Status column e Pending images are waiting to be sent e Sending images are in the process of being sent e On Hold images have been paused and will not be sent until you resend them e Cancelled images will not be sent e Failed images were not sent successfully but you can resend them 76 Chapter 6 Distributing Images and Using DICOM e Images with a status of Permanently Failed have failed for a more serious reason and cannot be resent e Completed images have been sent successfully Note The status listed for each study or series represents the most urgent status for any image in that study or series For example if one of the images in a study has a status of Failed but the others are all Completed the row for that study will display Failed in the Status column That way you know that there is a failed image within the study that you may want to resend A priority of high medium or low is listed for each image in the Priority column High priority images are sent first then the medium priority images and finally the low priority images Images in the same series all have the same priority Note Be careful not to confuse the Status column with the Status Details column which initially displays as Status To use the outbound DICOM queue e The information displayed by the DICOM queue changes during the sending process The information in the table is every few seconds To see the most current informa
340. u want to be added to or subtracted from the current level value For instance typing 500 will add 500 to the current level value while typing 500 will subtract 500 9 Click Save The new preset appears in the list of presets displayed in the Presets information of Preset the Imaging Configuration window Follow the instructions in 10 If you do not want this preset to be displayed in the Image Viewer check the Hide check box for 5 11 3 Creating a New Preset this preset You can only hide user presets system presets are always visible from the Image Viewer The new preset that you create To copy an existing preset will be based on the window 1 On the Controls menu select Defaults gt Imaging level settings currently applied to the image which are the settings from the system preset 2 On the left side of the Imaging Configuration window select Presets 3 Ifyou are the Administrator and you want to edit a system preset copy the System tab If you want to copy a user preset click the tab with your user name 105 select a preset and then click Copy The Presets Configuration Detail dialog box appears The Name text box displays the name of the preset you are copying with the words Copy of added to the beginning All other text boxes are filled with the same values as the preset that you are copying Change information in the Name and Modality text boxes To change window and level values by specifying exact values
341. ual noises Inspection Daily Detector plate self test as described in Turn system on and observe following procedure To perform the detector plate self test 1 Turn on the power to the IDEXX DR 1417 system The detector initiates a series of self tests 2 Observe the LED on the black box e Ifthe LED is green the detector has passed the self tests After the 30 minute warmup period use the system as normal e lf the LED is blinking orange red an error occurred in one of the self tests Contact IDEXX customer support before using the system In the U S or Canada call 1 877 433 9948 15 5 Servicing servicing of the IDEXX DR 1417 system may be carried out only by personnel authorized by IDEXX The correct setting of the electromechanical and electronic components affects system function image quality electrical safety and the radiation exposure of patients and medical personnel IDEXX recommends that you e Carry out the inspections indicated in the above table on a regular basis 154 Chapter 15 The IDEXX DR 1417 Digital Imaging System e Have the device serviced at least once a year by IDEXX Devices used very often may need to be serviced more frequently A service contract with IDEXX helps you preserve the value and safety of your device All necessary servicing including safety inspections for preventive hazard protection is performed at regular intervals IDEXX coordinates service intervals with you depending on the s
342. ufacturer s declaration electromagnetic immunity The scanner is intended for use in the electromagnetic environment specified below The customer or the user of the scanner should assure that it is used in such an environment Immunity test IEC 60601 test level Compliance level Recommended separation distance Conducted RF IEC 3Vrms 3 Vrms 61000 4 6 15 kHz to 2 5 GHz Radiated RF IEC 3 Vrms 3 v m 61000 4 3 15 kHz to 2 5 GHz Note At 80 MHz and 800 MHz the higher frequency range applies Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to any part of the scanner including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter dare d 1 17 VP 80 MHz to 800 MHz 6 236 WIP B00 MHZ 20 2 5 GHZ where P is the maximum output rating of the transmitter in watts W according to the transmitter manufacture and d is recommended separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of Ca equipment marked with the following symbol A Note These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field from fixe
343. urned on e The scanner System LED is green 16 8 Inserting an Imaging Cassette WARNING Do not attempt to operate the scanner without an imaging cassette loaded in the machine Note Io ensure proper radiograph orientation when taking radiographs place the animal s head over or near the red arrow on the cassette For extremities point the animal s toes away from the red arrow Face white side To load a cassette into the reader 1 Be sure that the scanner is turned on and the System LED is green Open end 2 With the white side facing up and the open end pointing toward the Figure 16 4 The proper orientation of the imaging cassette reader place and center the cassette on the cassette tray Note Most cassettes have an arrow in the middle of the open end When inserting a cassette always line up this arrow between the two LEDs on the scanner 3 Slightly push the cassette into the scanner until it reaches the locked position and the Process LED turns orange and starts blinking The screen is automatically pulled from the cassette and loaded into the scanner and the Process LED changes from orange to green Chapter 16 The IDEXX CR 1417 Digital Imaging System 16 9 Removing an Imaging Cassette After reading an image the scanner automatically erases the screen so that It is ready for the next use The imaging screen is then ejected into the cassette the cas
344. used e The screen is very flexible Handle with care to avoid dropping it e Hold screen by the edges and by the back side The side that faces away from the x ray tubes e Wipe the screen with a clean nonabrasive lint free cloth and screen cleaning solution e Take care not to scratch the active surface during cleaning Note The scanner manufacturer recommends using CARESTREAM formerly Kodak screen cleaner to clean the imaging screens To obtain screen cleaner contact IDEXX Digital Imaging Support at 1 877 433 9948 IMPORTANT CARESTREAM screen cleaner should be used only with Kodak or CARESTREAM screens AN Read and follow the instructions in the manufacturer s Material Safety Data Sheet MSDS prior to use CAUTION 185 Chapter 18 The IDEXX I Vision CR Digital Imaging System AN Never insert an imaging screen into a cassette unless the screen and cassette are a thoroughly dry Do not use alcohol or alcohol based products on Kodak or CARESTREAM screens Avoid AN letting the imaging screen come in contact with isopropyl alcohol isopropanol rubbing caution alcohol hydrogen peroxide and other peroxides citrus based cleaners hand lotions and waterless hand sanitizers as well as surfactants and lubricants These materials may cause visible or hidden damage to the screen and could result in immediate or future image artifacts Figure 18 7 The extraction tool To remove and clean an imaging screen Extraction
345. value shown in the center 4 Be sure that the annotation Pointer tool is selected and adjust the Norberg angle template by doing the following 5 2 3 The VHS Tool This tool is available only in the IDEXX PACS software formerly the IDEXX Digital Radiography module or in the Diagnostic Imaging module purchased with earlier versions of Cornerstone software The Vertebral Heart Score VHS tool is used to measure the size of the heart in order to determine if it is enlarged The VHS is determined by measuring the length and width of the heart and then comparing these measurements to a section of the thoracic vertebrae Essentially you measure how many vertebrae Chapter 5 Reviewing Images u then click Norberg Angle 6 To move the entire template click the solid lines anywhere outside of the circles and drag To change the angle of one of the femoral head to rim of acetabulum lines click and drag the small square handle This handle is on the line near the circle 16 15 To move a circle click the center point and drag 96 63 To adjust the size of a circle around the center point click the small round handle and drag jaa To adjust the size of a circle relative to a fixed edge point click the small round handle and drag it to the point on the circle that you want to be fixed in place Then click elsewhere ON Figure 5 2 An example of the Norberg angle the circle to create a second handle and drag this handle t
346. ve DICOM Imaging you gain the ability to use the DICOM standard to import and send out images as well as a number of advanced imaging features IDEXX PACS software lf you have an IDEXX Digital Imaging system you have IDEXX PACS software with all the Cornerstone Imaging and DICOM Imaging features In addition you have the ability to capture radiographs along with features to make the image capture process more efficient Note In some instances you may be able to purchase IDEXX PACS software as an upgrade even if you do not have an IDEXX Digital Imaging System For more information contact your IDEXX Cornerstone sales representative at 1 800 283 8386 You can add image request and results functionality that helps you more fully integrate your practice s imaging devices with Cornerstone IDEXX SmartLink technology used with IDEXX Digital Imaging systems SmartLink integration lets you request radiographs quickly and easily from anywhere in your practice reducing double data entry and reducing missed charges Modality Worklist Integration used with DICOM Imaging Modality Worklist Integration lets you request radiographs from non IDEXX imaging systems such as ultrasound and CT devices As with SmartLink technology Modality Worklist Integration also helps to reduce missed charges and add completed images to the medical record However the exact level of billing and medical record integration depends on the capabilities of the devic
347. ve to save and close the Imaging Configuration window or click Apply to save without closing the window To edit a keyword in the list 1 2 Select a keyword in the list Type your changes and click Save to save and close the Imaging Configuration window or click Apply to save without closing the window gt lo delete a keyword from the Keyword list select a keyword in the list and click Delete Note A keyword cannot be deleted if it is associated with an image 103 Chapter 8 Setting Up Basic Imaging Features 8 9 Setting Up Multiple Monitors You can customize Cornerstone to display windows on more than one monitor If you have two monitors the Patient Clipboard Image Explorer window and other windows will be displayed on one monitor and the Image Viewer will be displayed on the other If you have more than two monitors you can display a separate Image Viewer on each additional monitor To set up multiple monitors 1 On the Controls menu select Defaults gt Imaging 2 On the left side of the Imaging Configuration window select Monitor Preferences 3 Inthe Monitor Settings table all the monitors that are set up for your computer are listed in the Monitor column Select the check box in the Use Monitor column for each monitor you want to use if it is not already selected 4 When you are finished click Save to save and close the Imaging Configuration window or click Apply to save without closing the window
348. vel to the way they were when the image was captured The first image is preserved and the next exam type is automatically selected in the list 10 Another cassette can be scanned when both lights are green and steady If you want to capture an image for a different exam type next click that exam type to highlight it 11 Repeat these steps until you have taken all the images for this patient All captured images are saved to the database when you click Done Capture to complete the capture process 10 5 3 Using the IDEXX I Vision CR or IDEXX CR 1417 Model 140 140R Digital Imaging System If you are using IDEXX I Vision CR System this part of the image capture process is slightly different depending on the driver software that is installed on your scanner TIP The shot tree menu contains other e f your system was installed using Cornerstone 8 3 or higher you are probably using the new features that allow you to customize scanner software Follow the instructions for the newer scanner software below your image capture session See e lf you are using the Windows 7 operating system and have updated your Cornerstone Ve ee Me rea Ue software to version 8 3 or higher you can contact IDEXX Digital Imaging Support if you wish to upgrade to the new scanner software With the upgrade you will no longer need to e Adding an exam type reselect the view on the blue scanner interface window as part of the capture process Follow Looking at the
349. vider s Web site 4 Use the attachment feature on the telemedicine provider s Web site to attach additional images or supporting material 5 Close the provider s Web site Chapter 4 Cases and Telemedicine 29 Chapter 4 Cases and Telemedicine 4 4 Managing Cases To open an existing case from the Image Explorer 1 3 4 On the Image Explorer window select the Advanced Search tab and make sure that the Cases check box is selected search for the patient When Cornerstone returns search results the cases for this patient are shown in the Summary List area on the left Cases are marked with a case icon Double click the icon for the case you want to open The Case Detail window appears Figure 4 2 The case icon Follow the instructions later in this chapter to do a case action To open an existing case from the Patient Clipboard gt With a patient selected on the Patient Clipboard double click the image case in the Patient History area The Case Detail window appears To delete a case Ts 3 4 5 On the Image Explorer window select the Advanced Search tab and make sure that the Cases check box is selected Search for the patient When Cornerstone returns search results the cases for this patient are shown in the Summary List area on the left Cases are marked with a case icon Select the icon for the case you want to delete Click Delete The Cornerstone dialog box appears Click Yes The
350. w image request that is manually created c Select Specific staff to associate one staff member with all manually created image requests Then either type the staff ID in the Staff ID text box or click in the text box and press F2 to search for and select the staff member Figure 22 1 The Practice and Workstation Defaults window 6 Select an option in the Default invoice item class drop down menu to narrow TE eae en the list of items Cornerstone displays when you create an image request By specifying a default classification e g Radiology you can filter out nonimaging invoice items This speeds up the search process 22 4 3 Setting Up Invoice Items to Initiate Image Request Special Actions A special action is an option you can set up for an invoice item so that use of the item on the Patient Visit List PVL or invoice will automatically prompt Cornerstone to perform a certain action With the new Image Request special action available in Cornerstone 8 2 invoice items set up to initiate the Image Request special action will activate the New Image Request dialog box when the item is added to the Patient Visit List PVL or invoice for a patient Note For those practices already using SmartLink Digital Imaging when you install Cornerstone 8 2 or higher any existing imaging invoice items with linked shots will be automatically set up with the Image Request special action and the applicable shot will be selected in the shot tree Th
351. w thumbnails of the images you find For more information see the searching instructions in 2 2 2 The Search Area Advanced Search Tab To select multiple items gt If you want to select more than one item on the Dashboard lists hold down the CTRL key while you select the items you want Chapter 9 Imaging Systems Overview 115 Chapter 9 Imaging Systems Overview To deselect Items gt If you want to deselect something that you have selected click again while holding down the CTRL key The item is no longer selected 9 2 How Images Series and Studies Are Named Images series and studies are all named during the capture process Bi Skull eee okul Right Lat The shot exam type names that you choose on the Capture Setup window become the names of the radiographs that you capture on the Image Capture window In Figure 9 2 Skull Right Lat and Skull VD are examples of exam types The next level up in the menu shown on Figure 9 2 is Skull which becomes the name of the series Figure 9 2 Shot exam type names The date and time when you begin the capture process becomes the name of the study Note While the names that are described above are what you almost always see for images that you Capture with Cornerstone there are a few exceptions of which you should be aware o lf you import images from DICOM compliant devices such as endoscopes or ultrasound machines Cornerstone impor
352. ware Is Installed Separately eiii 118 10 4 Starting the Capture Process without a Capture Request uusesseeesrrrisrrrrririririereerrrrerrrrrrrrrrn 120 10o Gaptunng The Mags p eee ne renee ee eee meer er ee ee TC ee ee ee eee 121 10 5 1 Using the IDEXX I Vision DR or IDEXX DR 1417 Digital Imaging System ccees 121 10 5 2 Using the IDEXX CR 1417 Digital Imaging SYSISM ws sssscscccscnencnemencnencacietspansasgsnsnsneasnarederecedeceens 123 10 5 3 Using the IDEXX I Vision CR or IDEXX CR 1417 Model 140 140R Digital Imaging System 124 10 5 4 Using the IDEXX EquiView Digital Imaging SYSTOIM cccccccccccccccccsseeceseeseceeeeeeseseeeeeeeeeeeess 127 10 6 Reviewing ihe IMAGES ssteissi iniaiaiai oa States pana aaia bi a a anie 128 107 compeing ihe ATU FIOO S oessa ner nace ancenaceanessassansisres saesde dan EERE ETE RTE RAE kirikiri enir E UER i 129 Chapter 11 Image Coach and Other TOols ccccessceeseeeeeeeeseeeeeeeeeeeeseeeeeeenneenaesonseneaeneneees 130 11 1 Image Coach Features sacs aac canceactentiasncesdleondesanndadiuatadedtuadawtancsdteaaneddaiaaneanieiededuhetadehabaedeaciesderauineetenedes 130 Ii eee tl URN Male NGM IGM AlO eas sc dapsone ctr ied iere Sa a sale aaan 130 11 1 2 Reference Radiographs cccccsssssssssssscceeeeeseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeseennnnnentnsgs 130 IERO 2 DO IO eee eee nee RPT ere en ar ee a ee ee eee ere ree 131 11 2 SCC US Tl OM
353. window and level to the way they were when the image was captured 7 Another cassette can be scanned when both lights are green and steady If you want to capture an image for a different exam type next click that exam type to highlight it 8 Repeat these steps until you have taken all the images for this patient All captured images are saved to the database when you click Done Capture to complete the capture process 10 5 4 Using the IDEXX EquiView Digital Imaging System To capture images with the IDEXX EquiView Digital Imaging System 1 Inthe shot tree area on the right of the Image Capture window the first exam type in the list is automatically highlighted e lf you want to take this image continue with step 2 e If you want to take a different image click the exam type for that image TIP The shot tree menu contains other features that to highlight it allow you to customize your image capture session See 11 3 Dynamic Shot Tree Features for Capture for more IMPORTANT For best image quality the body part that you are imaging P N must match the exam type that is highlighted The exam type that is selected in the shot tree determines image processing values and the image Removing an exam type from the shot tree orientation Retaking an image taking additional radiographs for WARNING Do not run other programs at the same time as the Cornerstone an exam type system Running other programs during the capture process may
354. wing the Patient CD tab SOAP Selection Screen dialog box lil Click OK The medical notes you have chosen are displayed in the Medical Notes SOAP text box where you are able to edit them If you want to add annotations or overlays to the JPEG files that will be included on the CD click Apply Annotations and or Apply Overlays Click Create CD DVD Note If you want to save this case to create a patient CD later click Save and Exit and return later to continue this procedure The Patient CD Progress box appears When the files are ready the CD DVD burning will start momentarily message is displayed 32 Chapter 4 Cases and Telemedicine 8 Click OK 9 When the process is complete the finished CD is ejected automatically Note Once you create a patient CD you cannot add to or change the information on the CD To save patient CD information for a case to a file location Use this process if you want to bypass the patient CD process You might do this if you want to put the images in an email or on a USB flash drive or you might want to compile the information for patient CDs throughout the day and then burn the CDs at a later time using the CD burning Capabilities in the Microsoft Windows operating system 1 On the Case Detail window if the Case Actions pane is not open click Expand gt gt 2 Click the Patient CD tab The patient CD options are displayed 3 Select File Folder and type the file folder l
355. with the version that was originally captured Click Add to Workspace to add an image to the workspace where you can hold images from more than one client in order to compare them Click the Create Patient CD button to save images series or studies to a CD Click the Print button to print an image Click the DICOM Print button to print an image to a DICOM printer Click the Send DICOM button to send an image series or study via DICOM to a chosen destination Click the Email button to send images series or studies via email Click the Add to Case button to add an image to an existing case Click the New Case button to create a new case and add an image to it Click the Reassign button to reassign a study to a different patient Click the Delete button to delete images Chapter 2 Program Basics Client E i Cale Michael Gta Holly oi 0427 2009 G E 10 07 2008 i a Medium A osf25 2008 tee Abdomen oe Maple Sugar Ei 04 27 2009 Patient Date images captured Study Figure 2 3 The Summary List Area 18 Chapter 2 Program Basics 2 3 About Image Series and Study Image series and studies are important concepts in Cornerstone The images that you capture are organized into series and studies Often when you use the software to perform some action such as emailing images creating a case or creating a patient CD you will be asked whether you want to perform that activity on the image
356. work set up with Cornerstone mobile computing the Cornerstone server contains the database and copies of all the images while workstations request images and information from the Cornerstone server as needed Mobile computers exchange information and images with the Cornerstone server when they are connected to the network during the synchronization process Overlays Overlays contain information about the image that can be displayed in the Image Viewer such as patient name date of birth series title and modality Much of the same information is also contained in a DICOM file created for the image Pixel Pixels are small bits of data that make up an image SOAP SOAP is an acronym for Subjective data Objective data Assessment and Plan SOAP is the way that progress notes are organized in problem oriented medical record keeping Thumbnail A thumbnail is a miniature view of an image in the patient s image record and case TWAIN TWAIN refers to a standard protocol and application programming interface that enables software applications to communicate with imaging devices Such as scanners and cameras Applications that support TWAIN have a standard method for acquiring images 2 0 Customer Support and Information U S or Canada IDEXX Digital Imaging Support 1 877 433 9948 IDEXX Digital Imaging sales and information 1 877 433 9922 Cornerstone Support 1 800 695 2877 Cornerstone sales and information 1 800 283 838
357. ws you to view image shots selected for a request e A View Images button that allows you to open Completed Partial or Not Requested images in the Image Viewer e A modality filter e Amodality type column in grid allowing you to see what modality type was used on a request To manage image requests and results 1 Click the Image Requests and Results Ed button on the toolbar The Image Requests and Results window appears 2 To narrow the list of image requests displayed do one or more of the following If you want to narrow the list of image requests displayed to only view requests modified within a specific time frame select a Last modified timeframe in the Date range area If you want to narrow the list of image requests displayed to only view requests having a particular status select or deselect the check boxes in the Request status area o Requested items are radiographs for which images have not yet been captured Note If an imaging system does not support MPPS the status remains at Requested See 22 5 8 Manually Setting Requests to a Status of Completed Completed items are requested radiographs that have been captured Note If an image request does not have any default image shots assigned the request is considered Complete if any shots are captured for the request Note If you have filtering options set to display Completed items with the Last modified timeframe set to All the image request list will d
358. x To remove a print job from the queue select that row in the table and click Delete Click Save to save the edited queue 4 Click Close 6 3 Sending Images Via DICOM Cornerstone offers the ability to send your images to other DICOM enabled servers You can send images via DICOM from either the Image Explorer or the Image Viewer The DICOM standard was developed for human medical use but has been widely adopted in the veterinary community DICOM allows image files to be sent between different hardware and software systems In addition to a diagnostic quality image a DICOM file contains information about the image and about the patient DICOM is useful for sending images between veterinarians to specialists or to prepurchase registries as long as both sender and recipient are using DICOM compliant PACS Picture Archiving and Communication System software Because patient data is sent with the image that information does not need to be re keyed on the receiving end Before you send images via DICOM you need to set up information about the DICOM servers to which you are sending the images See 8 3 Setting Up DICOM Services for information about setting up DICOM features The recipient of the images will probably also need to enter information into their software about your computer and your Cornerstone software Note By default the DICOM file that is sent is the original version of the radiograph as it looked when you click
359. xes 3 Some elements may have more than one choice available for example an element that sets orientation might have portrait and landscape as choices e f there is only one choice for this element or if you know you will only want to use one choice type the choice in the Default text box e lf you want to set up multiple choices click Choices For each choice click Add and type the name of the choice in the Choice text box When you are done click OK 4 Click OK to close the Configure DICOM Printer Element dialog box Note Be sure to click Save on the Select DICOM Printer dialog box when you have finished all configuration work for this printer To configure DICOM printer constraint settings 1 On the Select DICOM Printer dialog box click Constrain to display the Constrain DICOM Printer dialog box 2 For each display format you want to configure click Add A new row appears in the table 3 Type the name of the format in the Display Format text box Chapter 8 Setting Up Basic Imaging Features BF contigue COM Printer Bement Tari Be Painter Lord itepe Latics Figure 8 2 The Configure DICOM Printer Element dialog box P Configure DICOM Element Choice Orientation Landscape Portrait Figure 8 3 The Configure DICOM Element Choice dialog box 111 Chapter 8 Setting Up Basic Imaging Features Note Each display format name you type here must exactly match the format
360. your IDEXX digital radiography system The relay box replaces the black and white boxes that were used in earlier DR system configurations 21 2 Background on Generator Interfaces Two kinds of high voltage HV generator types are generally found at veterinary practices After the relay box is installed the foot switch works the same with either kind of generator press the switch half way to prep and the rest of the way to expose However the foot switch works differently when the two types of generator are used with film or other non DR systems so this is one way to differentiate between generator types e The majority of HV generators work the same way in DR or non DR system press the switch half way to prep and the rest of the way to expose These prep expose generators are connected to the relay box with three or four wires e A smaller number of HV generators are pulse two step generators where in a non DR configuration you press the foot switch once to prep and a second time to expose 21 3 Using the IDEXX DR Relay Box The front panel of the IDEXX DR Relay Box is shown below Siow Blink IDLE Fasi blink READY Blink PREPPING XAY TEST Steady TEST MODE Steady INITIALIZIHG ER POUSURE 229 Chapter 21 The IDEXX DR Relay Box The table below shows how the LEDs on the box are illuminated to indicate the state of the system and or to indicate what action you can take What you do Turn on the generator Slow bli
361. z d ii7ve d 1 17 vP j Dee ve 0 01 0 117 0 117 0 233 0 1 0 37 0 37 0 737 1 1 17 1 17 2 33 10 3 7 3 7 7 36 100 mi7 11 7 23 3 For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer Note At 80 MHz and 800 MHz the higher frequency range applies Note These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 196 Chapter 18 The IDEXX I Vision CR Digital Imaging System 18 8 Explosion and Implosion Hazards A CAUTION Caution observe the following Do not operate the equipment in the presence of explosive liquids vapors or gases Do not plug in or turn on the system if hazardous substances are detected in the environment If these substances are detected after the system has been turned on do not attempt to turn off the unit or unplug it Evacuate and ventilate the area before turning off the system 18 9 Overheating A CAUTION Caution Do not block the air circulation around the scanner Always maintain at least 6 inches 15 cm clearance around the scanner to prevent overheating and damage to the system 18 10 Laser Safety Information The IDEXX I

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