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Catella Diagnostic Workstation Manual-330-4-001-rev05 06

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1. Volume Levels 3 Pre Recorded Volume Level 0 9 9 Dictation Volume Level Worklist Order NoSkip skip or noskip patients without current images RIS or 24 hours 24 Ifno RIS Number of hours an image is aged before it is considered diagnosed for worklist skip Scribe none 192 168 0 30 None scanner TCP IP address for SCRIBE Server or Reports Machine NONE for none 25 12341 Scribe port unique for each Catella Figure 36 Example of first part of digams ini file Form 330 4 001 Rev 05 Page 51 American Medical Sales Inc catea Diagnostic Workstation User Manual Printers none hp840c Verified Report printer or NONE none Codonics NP 1660M Summary Report printer or NONE hp4500 none Codonics NP 1660M Image printer or NONE may be multiple printers until blank line Fuji DICOM 2nd Image Printer Dicom Catella DICOM Information on main Catella DICOM engines 37703 Archive Hub DICOM listening port X for DICOM Disabled no YES NO for encrypted reception 36877 Web Server Port yes sencrypted reception NO DICOM window displayed Yes or No Yes for diagnostics PreFetch Rules for Prefetch one rule per machine None get none All All Archived Images LMB Last Study of same Modality same body part if possible NONE Gateway Dynamic Address Information 3 lines to send message to Gateway informing it of the Address of this workstation blan
2. MORE ADVANCED TOOLS The basic image tools were addressed in Chapters 2 and 4 Chapter 5 focuses on COELLOS advanced imaging tools Types of Controls The CAQUELLO system divides commands into four categories These are L Image manipulation Tools that alter the display of the image such as zoom pan rotate etc 2 Image status Tools that allow movement of files or show information about the image file such as entry of diagnostic status or display of DICOM header information 3 Worklist Management Tools that allow you to access the list of images to be read and to allow random access to this list Functions such as Query Retrieve are included in this tool group 4 Miscellaneous This category includes functions such as user options printing and system management Advanced Image Manipulation Tools Rotate The Rotate function turns the image 90 in a clockwise direction each time the function is selected Click on ROTATE on the Activity Menu Flip Image The Flip Image function flips the image 180 on the vertical axis Click on FLIP IMAGE on the Activity Menu Reset The Reset function returns the image on the active image area to its DICOM Window Level settings as sent from the modality Click on RESET on the Activity Menu in the Window Level Section Invert The Invert function reverses the black white scale for the selected image Click on INVERT on the Activity Menu in the Window Level Section W
3. cat ELl o DIAGNOSTIC WORKSTATION USER MANUAL Version 4 0 CE Revised July 2005 330 4 001 Rev 05 2005 AMS American Medical Sales Inc caceLLa Diagnostic Workstation User Manual v 4 0 Table of Contents TABLE OF FIGURES CHAPTER 1 INTRODUCTION Indications for Use Key Concepts Power of Digital without the Complexity of Computing Eliminating Icons Increasing Productivity DICOM Compliant Manual Conventions Special Helpful Hints for Reading this Manual CHAPTER 2 CALELLA WORKSTATION COMPONENTS The catel a Workstation Display Trackball Keyboard Information Network Databases DICOM Push DICOM Query Retrieve Other Databases DICOM Print CHAPTER 3 STARTING THE catclLLaWORKSTATION Powering Up the CaUCLLd Workstation Starting the CACCLLA Program Passwords On Call Status What the On Call System Does CHAPTER 4 PRIMARY IMAGE CONTROL TOOLS Monitor Control Primary Image Control Tools Zoom Pan Window Level CHAPTER 5 MORE ADVANCED TOOLS Types of Controls Advanced Image Manipulation Tools Rotate Flip Image Reset Invert Window Level Measure Annotate Thumbnails Form 330 4 001 Rev 05 lt WNNNNR Ke O UNUNUN DAAA A American Medical Sales Inc catceLLa Diagnostic Workstation User Manual v 4 0 Image Details 19 Print Image 20 Creating a CD 20 Logout 20 Quad Display 21 Overlay 21 Locator Select 21 Move Resize 2 3D 24 C
4. contact American Medical Sales Inc COUCLLO products can operate in non DICOM environments as well Manual Conventions There are a few things to be aware of while following the directions in this manual CQUCLLO employs a very simple user interface controlled primarily by a two button trackball or mouse Extremely limited keyboard use is necessary within COUTELLO The trackball or mouse is used to select commands and move about the viewing area When the manual directs you to CLICK on a command or selection move the trackball so the cursor is over the Form 330 4 001 Rev 05 Page 2 American Medical Sales Inc cate La Diagnostic Workstation User Manual desired command and press and release the left button A single click is all that is necessary Double clicking is not used in the COUCLLO Workstation system If a command button is grayed out this means that that command is not functional for the particular image being viewed Example of Grayed Out Button Not Acti Example of utton Not Active Active Button Quad Display In some cases there is a need to grab and drag an object Move the cursor over the desired object Hold the left key down The object can then be dragged to the desired location by moving the trackball while keeping the button depressed Specific functions will be explained in detail in other parts of this manual The screen displays in this manual may not appear exactly as
5. 42 42 44 45 47 49 51 53 54 Page iv American Medical Sales Inc caceLLa Diagnostic Workstation User Manual v 4 0 TABLE OF FIGURES Figure 1 A COLELLO 2 Monitor workstation with an additional Navigation Monitor for RIS or 3 D 4 Figure 2 Location of display elements on a COUCLI_O Monitor ee eeececcceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 4 Picure 5 Trackball CONDONE N Sin an EN hates celta aia etal ae naa aaa ated 5 Figure 4 Zoom Pan Window Level and Stack Control Icons cceccccccccccecceesseeeeeseeeeeeeeeeeeeeeeaeaaaaeeenees 5 Figure 53 o E LET Starvor Short Cut COT ia cees en cosa tie wed E 9 Pigure O Individual User ist BOR iia a E E E N 10 Fearon e RP wO BOX aaa E AEN 10 Pieure s Detault Lay Out o ACU V0 M EMU eein Taaa EE E E 12 Figure 9 Advanced WINDOW LEVEL Option BOX sigist arien E EE ee 14 Preure 1 0 Measure Method Selection BOX adieren a an E E E anise 16 Figure l1 Length Measurement Information BOK ss sseeoscie icrit enres eK E EEEa AAE EEE ATE 16 Figure 12 Length Measurement Information Box with Calibrated Result ce ccecccceceeeeeeeeeeeeeeeeeeees 16 Figure 13 Views of Measurement Windows Showing Distance Angle and Hounsfeld Units ROL 17 Fiore TA Annotate SWIMM seee iveene e E E AAEE EA E 18 Figure 15 Thumbnail Column shown on left side of screen cccecccccccccccceceecceceeceeceeeeeeeeeeeeeeeeeeeeeeeeeey 19 Figure 16 Example o
6. Click on HOUNSFELD UNITS button Units ROI 2 Move cursor to area of interest 3 Holding the left button down draw a circle or ellipse to create the Region of Interest ROI 4 The average maximum and minimum values for the ROI will appear in the measure box The figure below shows an image on a monitor with the three types of measurements ic When calculating ROI values all pixels on or inside the perimeter of the circle or ellipse are used Measure C Distance C Angle G Hounsfeld Units Average 269 84 Max asl Min 196 Figure 13 Views of Measurement Windows Showing Distance Angle and Hounsfeld Units ROI Many measurements can be made on an image To clear measurements from the screen select Annotate edit select measurement and then delete Cos When using a color monitor each type of measurement is displayed using a different color Distance blue Angle yellow Hounsfeld Units Annotate Occasionally the radiologist will wish to highlight and annotate images in a study so that this information can be transferred to the referring physician Select ANNOTATE from the Activity Menu A special Annotation submenu will appear on the left side of the Activity Menu Form 330 4 001 Rev 05 Page 17 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Annotation Compression Arrow Circle Text C Best Quality Write Resolution Middle 1750x2126 Act
7. Sales Inc cate La Diagnostic Workstation User Manual CHAPTER 4 PRIMARY IMAGE CONTROL TOOLS All COUCLLO image controls may be accessed through the Activity Menu See Chapter 2 for trackball control The most commonly used controls ZOOM PAN WINDOW LEVEL may also be accessed using your trackball or mouse buttons ic Commands issued through the Activity Menu are presented in this manual in capital letters 1 e CLICK on ROTATE Monitor Control COUCLLO s Activity Menu is located at the bottom of each screen It governs the images on that screen A column of thumbnails representing each image series available for the current patient is located on the left side of the left screen and on the right side of the right screen These default locations may be moved and a new user specified layout may be defined See Chapter 5 description of Move Resize feature for more details on customizing your screen configuration The location of the cursor indicates which monitor is the current active monitor The active monitor is the one that will be controlled by the associated Activity Menu Figure 8 shows the default layout of the Activity Menu Reason PAIN Stu M a sure Quad Display Figure 8 Default Layout of Activity Menu Primary Image Control Tools Zoom Images are placed on the monitors so that they use as much of the screen as possible MR CT and Angiography multi frame images are presented in Stac
8. and repair time are billable and are charged in 15 minute increments Form 330 4 001 Rev 05 Page 45 American Medical Sales Inc cate La Diagnostic Workstation User Manual How to Contact Us Mailing Address American Medical Sales Inc 4928 West Rosecrans Avenue Hawthorne CA 90250 6616 U S A E Mail catellasupport digitalams com Please note that e mail support is only available during normal business hours American Medical Sales Inc business hours are approximately 6 00AM to 5 00PM Pacific Standard Time Monday through Friday E mail is checked several times each day by our support personnel This method of inquiry should be used for more in depth questions that are not time sensitive Fax Number 310 219 3201 Telephone Number 310 219 3200 American Medical Sales uses an advanced voice mail system to support your needs If a support operator is not available please listen to the message carefully Messages for non urgent inquiries should be left and will be answered as quickly as possible If your inquiry is urgent and an operator does not answer your call listen to the message to activate our emergency response system Form 330 4 001 Rev 05 Page 46 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 18 IMPORTANT NOTES CateLLa Workstations display pre recorded and previously stored digitized diagnostic images patient information and associated data using computer system
9. button changes to the STOP button once the run command is given Loop Plays the images in a continuous loop from beginning to end Sync You can move multiple series shown on the same monitor together at one time To do this engage the Sync function on the monitor Window Level Source The workstation displays the stack using the window and level values found in the DICOM file These may differ for each image You may use the Window Level functions to adjust this display as you would for any other type of image See Chapter 4 fool Ji f Wy i rl g E rl lE EYE oom 1045 l Pan In addition the current frame number and the total number of frames is displayed Form 330 4 001 Rev 05 Page 33 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 9 CINE IMAGES Setting Display Configurations You may select how you wish to view cine image files Images can be viewed in 1 up or Quad two over two All imaging tools function with any configuration COUCLLG automatically adjusts the zoom factor of the images to take advantage of the monitors full viewing area Basic Image Controls Same as Others When viewing cine image files all the same basic image controls are available These include Zoom Pan Window Level Invert Rotate Flip Image Measure and Reset In addition loop viewing and image scouts with line locators are available for cine image
10. highlight one or more lines with a click of the left button lt PATIENT NAME gt Click on GET SELECTED IMAGES to begin the retrieval process This patient s image files will appear at the end of your worklist when they have transferred to COUCLLQ To remove the highlighted status click on the name again Moving Between Levels COUCLLG provides a productive method for moving up or down the DICOM storage hierarchy The QUERY button lower left changes its second line descriptor to describe the next lower level It starts with Patient Level changes to Study Level then to Series Level and finally to Image Level To move down to the next image level click on this first QUERY button To move up a level click on the UP QUERY LEVEL button Select Desired Images Now that you have determined the level you wish to retrieve from pulling the images to your worklist is simple Click to highlight the line that represents the image s you wish to retrieve You can retrieve more than one item by highlighting as many lines as desired See example in Step 6 above You must select at least one item before using the GET SELECTED IMAGES Command To exit the Query Window click on the EXIT button Logout Logout allows you to end your reading session This will take you back to the COUCLLO login screen and allow another doctor to use the CQUCLLO Workstation Method Close Worklist Window _ Activity Menu Clickon LOG
11. into coronal and sagittal anatomical planes COUCLLO s MPR program allows the user to e Scroll through the series in the axial coronal or sagittal image planes e Utilize 2D measurement tools like length angle Hounsfeld units e Complete annotation Screen Layout Below is the default screen layout Note that each view is appropriately labeled axial coronal or sagittal s a td D rt Figure 28 Typical MPR screen presentation Screen Layout Using MPR is simple Move the cursor to any one of the images Once over the image the cursor changes to a set of cross hairs When the left trackball button is pressed the center of the cross hairs becomes the point of the cursor As you move the cursor in any direction the other images shift to show you the reconstructed images for that point Moving the cursor to one of the other images changes the reconstruction control to that new image ic Keep in mind that COUCCLLO only displays actual data points It does not interpolate information Therefore the best reconstructed images will be attained using CT or MR series with a large number of image slices spaced evenly and closely together Form 330 4 001 Rev 05 Page 35 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual ic If a series does not have the number or type of slices necessary to allow for reconstruction a minimum of four parellel slices is required the MPR butto
12. it down move the trackball in either a horizontal or vertical direction When you release the left button COUCLLO will indicate the line that you have just drawn and will request you supply its length Use the slide bar to adjust this as desired ARNING All measurements for this image will be based on this setting Try to keep the line either horizontal or vertical Horizontal and Vertical spacing assumed equal i OK Cancel Figure 12 Length Measurement Information Box with Calibrated Result Line Length 10 cm Form 330 4 001 Rev 05 Page 16 American Medical Sales Inc catre La Diagnostic Workstation User Manual Type of 2 Measurement Method Length Click on the DISTANCE button Move cursor to start point Press and hold left trackball button Drag cursor to desired end point and release button Measurement appears on monitor Click on the ANGLE button Move cursor to vertex of angle Click left trackball button Move cursor along one leg of angle At desired end of leg click left trackball button once Move cursor to desired second point The second leg of the angle forms as you are doing this and the angle measurement appears on the monitor oe oe le N 7 To set the angle click on the left trackball button again Hounsfeld 1 Click on HOUNSFELD UNITS button Units Single 2 Move cursor to area of interest Point 3 Unit values will appear in the measure box Hounsfeld 1
13. 1 Click on QUERY on the Worklist Window Step 2 The Query Window will appear See the figure below The name and ID of the current patient will appear in the Query Info Name box If you wish to query for a different patient click on the CLEAR PATIENT INFORMATION button Then fill in a new name or ID number Form 330 4 001 Rev 05 Page 27 American Medical Sales Inc cate La Diagnostic Workstation User Manual Figure 22 Query Window Step 3 Click on the QUERY PATIENT LEVEL button Cs The current status of your query will appear in the STATUS line on the lower right corner of the Query Window ic Helpful hints Entering Partial Names will bring back all patients with those beginning letters For example Smi will bring back Smilie Smite Smith etc Entering Partial ID will bring back all patients with those beginning characters The less specific an inquiry the longer it will take and the more results will be displayed Step 4 Select the patient name whose images you wish to retrieve Click on the GET SELECTED IMAGES button This will close the QUERY Window and open the WORKLIST Window When the retrieve is complete the patient study appears as the last item on the WORKLIST if sorted by time images have been received It can then be studied Overview of Query Levels Under the DICOM standard image files are stored in a specific hierarchy DICOM Hierarchical Level Layers Fi
14. F Patient Sex r Study Time Image Date F Patient Birthdate r Study ID m Image Time Patient Age F Referring Physician Reset DICOM 5 Ping Test _PeaTet OR Shutdown Log Out Figure 33 DICOM Transfer Tab About catclLLa This tab shows the current version of your software and other related information Identification Catella c American Medical Sales Inc 1998 2002 E 800 423 3535 version 3 1 6 All rights reserved IMPORTANT NOTES dchagodhe Maigii pihini formation mid risorti date anr Catella Wekitebend ll chapbhey pre recorded imd previcudly siarad dime oe Che udesa fecdkey capia yitma Pappbed wath ihe wotloralior cid detabaded wv elable f The intended purpose of this device is to low health cone professionals 10 wiew the electromecally avadable images and other patent information fa maer evelosion and posible iresiment plancang AD dgu magi wo aiid date deplored by Lies dirici are pregemied for the oterpretale fi T a hai na A ofthe health care profesional af ut any meaa Or paler informal Thad dete wilh data ee upon Che cnal iiored dalal maga oF aiita 4 Catala Scan is an amabing pofan and bardear davpre that allows the digtewtion of analog fiim mager Latella Fran eofuare inchade piha Galactus mage peebbeng eofiwaee bo capluee imaged Eih i venety of mamaechewar file ng end aiena devices Catella Scan OK Shutdown Log Out Figure 34 About COUCLLA Tab The Other Basic Butto
15. HAPTER 6 WORKLIST 25 Prefetch 25 Sortable Worklist 26 Select Mode 26 Cancel 27 Delete Mode 27 Query Retrieve 21 Overview of Query Levels 28 Conducting an Advanced Query 28 Moving Between Levels 29 Select Desired Images 29 Logout 29 CHAPTER 7 MOVING TO ANOTHER PATIENT S IMAGES 30 Basic Concept 30 Diagnosis 30 OK Next 30 Remarks 30 Verify 31 CHAPTER 8 MULTI FRAME IMAGES 32 Setting Display Configurations 32 Basic Image Controls Same as Others 32 Stack Viewing 32 CHAPTER 9 CINE IMAGES 34 Setting Display Configurations 34 Basic Image Controls Same as Others 34 Stack Viewing 34 CHAPTER 10 MPR MULTI PLANAR RECONSTRUCTION 35 Screen Layout 35 Screen Layout 35 CHAPTER 11 OPTIONS 37 Administrative 37 Identification 37 Tools 38 Window Level Preferences 38 DICOM Transfer 39 About Catella 39 Form 330 4 001 Rev 05 Page iii American Medical Sales Inc CoUCLLO Diagnostic Workstation User Manual v 4 0 The Other Basic Buttons at the Bottom CHAPTER 12 END OF SESSION Logging Off Shutting Down CHAPTER 13 catcLLa SCAN STATION CHAPTER 14 catc_LLa SCRIBE About Catella Scribe CHAPTER 15 ACTIVITY MENU amp TRACKBALL CONTROLS CHAPTER 16 WARNING MESSAGES CHAPTER 17 CONTACTING US CHAPTER 18 IMPORTANT NOTES CHAPTER 19 LICENSE AGREEMENTS APPENDIX A DIGAMS INI FILE APPENDIX B DOCTORS INI FILE INDEX Form 330 4 001 Rev 05 39 40 40 40 41
16. L_a Diagnostic Workstation User Manual CHAPTER 17 CONTACTING US First Support Contact Your system administrator has completed extensive training in the operation of the CAUCLLO Workstation and its software and hardware components This person is also most familiar with other aspects of your imaging network For these reasons the best place to start looking for assistance is your system administrator Second Support Contact In most areas of the world your CQUCCLLO system has been sold to your facility through an equipment retailer These medical imaging specialists have been thoroughly trained on the CQCCLLO system They will be particularly helpful in handling the hardware aspects of your system See your system administrator for their contact information Third Support Contact Please contact American Medical Sales for support that cannot be provided from either your system administrator or your local COELLO reseller American Medical Sales provides support help 24 hours a day seven days a week Please see below for the appropriate contact methods at the time of printing of this manual Please note the following restrictions Free telephone support is limited to the limited warranty provided at the time of purchase Usually this includes 2 hours of support per station purchased This support must be used within the limited warranty period provided with your purchase American Medical Sales support personnel will log the person c
17. MATION Active on QUERY screen to perform this function CONTRAST EQUALIZE An option under Window Level DELETE Selects images for removal Must be confirmed DELETE MODE _ Changes selection function on the Worklist DISTANCE Activates linear measurement tool DOWN QUERY LEVEL Moves query down one hierarchical level ERASE TO END To remove a portion of a dictation EXIT _ Terminates current operation FLIP IMAGE Flips image 180 around the up down axis of the active monitor GET IMAGES Query command to retrieve selected images HOUNSFELD UNITS Activates Hounsfeld Units measurement tool IMAGE DETAILS _ Displays DICOM header record for the displayed images INVERT Reverses the black white scale for the selected image LOCATOR SELECT Pick the image in the series to be used as the scout image LOGOUT Close reading session MEASURE _ Activates the measure algorithm MOVE RESIZE _ Reconfigure the elements of the monitor layout MPR Multi Planar Reconstruction OK Accepts status OK NEXT _ Issues normal diagnosis OPTIMIZE _ An option under Window Level OPTIONS Brings up Option Tabs OVERLAY Display image data found in the DICOM file for overlay QUAD DISPLAY SINGLE DISPLAY Shift from 2 over 2 to single image viewing PAN _ Activates PAN function PLAY BACK _ Allows review of recorded remarks PRINT IMAGE _ Sends image on active monitor to printer queue QUERY Activates initial query screen activates query
18. O catella WARRANTIES AND SERVICE PLANS COVER DAMAGE TO EQUIPMENT AND SOFTWARE CAUSED BY POWER SURGES VIRUSES OR IMPROPER HANDLING OF EQUIPMENT AND HARD DRIVES A UPS WILL HELP PROTECT YOUR INVESTMENT ic If using a UPS make sure that the power cords for the workstation s CPU and the Number 1 monitor are connected to the battery back up Once the computer is on the COCCLLO Workstation will power up into the Windows 2000 operating system This may take several minutes Once Windows 2000 is running you may be asked to provide a password to turn on the computer depending upon your institution s requirements Starting the CaCCLLO Program Passwords COUCLLO offers two levels of security Passwords are required to power up the CQUCLLOA Workstation and again to verify a reading doctor s identity when that doctor logs into a session Once the correct password has been entered a blank screen will appear on each monitor One screen will also have the traditional Windows Start button and the CQUCLLO short cut icon The Windows Start button can be used to access other programs and to shut down the workstation ame it I Figure 5 COUCLL_O Start or Short Cut Icon To activate the diagnostic reading software CLICK on the COUCLLO icon The doctor s log in list will appear Highlight your name and CLICK on the LOG IN button Form 330 4 001 Rev 05 Page 9 American Medical Sales Inc cartela Diagnostic Workstation Us
19. OUT Form 330 4 001 Rev 05 Page 29 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual CHAPTER 7 MOVING TO ANOTHER PATIENT S IMAGES Basic Concept Generally the reader moves to the next patient s images when he she has either completed a diagnosis or wishes to reserve judgment for later decision making perhaps to review the images with another healthcare professional In the case of diagnosis work there will be either a normal or an abnormal finding Many institutions have standard reports for normal findings In one study completed by a major film company it was found that 70 of all images receive a normal finding CQCCLLO has used this information to help make you more productive We have divided the movement function into two parts give a normal diagnosis and give a specific diagnosis Diagnosis COUCLLG takes advantage of the power of computers and the available DICOM information to reduce the time needed to complete your reading To do this COUCLLA divides the diagnostic process into normal and abnormal results OK Next Since the DICOM image already has the pertinent patient information you should not need to reenter or repeat this information into your dictation system COUTELLO also knows who you are and the current date and time If in addition your institution has standard normal reports for an image or study type this information should be able to be communicated t
20. See your system administration for details about your system HOWEVER in most systems all diagnostic workstations receive all images IF YOU ARE USING A DIAGNOSTIC WORKSTATION AND YOU ALREADY HAVE PERMISSION TO RECEIVE ALL IMAGES THEN THERE IS NO REASON TO EVER LOG IN AS THE ON CALL PHYSICIAN The only time that it makes sense to check the on call box on a diagnostic workstation 1s if not all images are routed to that workstation AND you are the on call physician In this case you will get all your normally routed images AS WELL AS those marked for the on call physician In most cases ON CALL SELECTIONS SHOULD BE MADE ONLY FROM REVIEW WORKSTATIONS AND WEBVUE WORKSTATIONS It is also important to note that these workstations are not typically used for diagnostic work Therefore reading on call images from these workstations should be considered as similar to wet reads of films The images will remain as undiagnosed on the network and on the Diagnostic Workstations On call images read on a Diagnostic Workstation may be diagnosed however and will thereafter drop to the Completed portion of the worklist Care should also be taken when reviewing on call images to avoid duplicate work Unless the on call images have been regularly pulled older images may be sent to your workstation Unlike other routed images the on call images are not purged from the list if another physician has already completed the diagnosis Again this is because
21. TE To stop the deletion click on CANCEL Deleted images will be moved to the Local Archive so they can be quickly retrieved in case of erroneous deletion Query Retrieve COUCLLO interacts with databases at your institution through a DICOM compliant Query Retrieve interface This interface knows how to translate your requests for information into a form that the database understands The database knows how to transfer your requests to COUTELLO In some cases this interface is provided by your institution in some cases by another manufacturer s component and in some cases by American Medical Sales ic Important definitions Query is the act of searching a database to see which images are available from that source Retrieve is the act of pulling the selected images to the COUCLLO workstation ic In most cases images are automatically sent to your workstation based on your institution s protocols The amount of time it takes to retrieve images on demand depends on your network and its configuration In general on demand Query Retrieve will reduce your efficiency If your system is not pre loading the historical images you need speak to your system administrator COUCLLOG will allow you to open another case for review while the selected images are being received You can view the retrieved cases later The easiest method to retrieve past patient images is to bring them all to your workstation To do this follow these simple steps Step
22. The available destination printers will be listed here See your system administrator if you would like additional printer selections added Destination Printer C HP4500 C FUJI DICOM CD Burner Cancel Figure 17 Printer Selection Screen Method i Print Image Activity Menu Click on PRINT IMAGE on the Activity Menu Creating a CD You can create copies of patient images on a CD if your network includes a COUCLLG CD Burner System The CD will include both the images and viewing software The CD will self play when inserted into most Windows based PC s If your network includes the advanced version of the CACCLLA CD Burner software it will also automatically print a CD label including information about your institution patient name and date of creation See the COCCLLO CD Burner manual for more details Logout Logout allows you to end your reading session This will take you back to the doctor login screen and signals COUCLLA that you are no longer actively reading images Where the COUCLLO Workstation can be accessed by more than one doctor this is an important safety step to prevent misreporting of the reading physician Further HIPAA requirements may make this necessary depending on physical access to the workstation Activity Menu __ Click on LOGOUT on the Activity Menu See Chapter 12 for more details Form 330 4 001 Rev 05 Page 20 American Medical Sales Inc cate La Diagnostic Workstati
23. a Worklist x iew Columns LH KA RF 4 MA g2 06 09 05 CAME Gern CT CROPPEDSPINE E 30 O6 06 05 CABELL HL 00136652 RF Caesar Julius 4 06 08 05 Burgers B 02552729 CT Cakum 40 06 03 05 0423452 WR Cervantes Chester 623 06 09 05 PARRVIEW 00125465 CF DAVID CiMey 5 06 06 05 CAMC Me 01163253 LS ECHO 1 06 06 05 kardiologi 999 0G 1 CR GRIMSBY EDITH 4 06 09 05 CAMC Gen 00302652 CT HOUSTON DAVID s 06 0605 CAMT ME 0230779 T HURBERT GEORGE 19 06 06 05 CAMO WO 00523252 CT KISMET TEDDY 14 06 0 15 CAMC ME 00585215 cr KNEE GEORGE 4 06 09 05 CAME Me O2652729 CT KRLIGMIAR MISERE oe 06 09 05 Oe Leo KE Knoof Angla bs 06 06 05 PAREVIEW 01657209 OT Robertson Sami 15 O6 00 05 GEPSINGE 02456779 BRE Skull Mallie 42 06 05 05 PAREVIEW 01443252 OT brings nancy 6 06 06 05 Parkview 02058160 Left click to VIEW patient image Space Free 17 879 Megabytes about 2728 chest ways or 445 071 MRI images Cancel Delete Mode Query Logout Figure 21 Worklist Prefetch Prefetch requests are generated by CQUCLLO workstations and need no connection to RIS or HIS systems The prefetch is automatically generated when an image is presented to CQUCLLO that represents an image for a new patient or new modality for the patient The request is user definable to include the most recent study ies with or without matching the current modality Since the COUCLLO workstation may generate prefetc
24. accordance with the accompanying written materials for a period of ninety 90 days from the date of receipt and b any American Medical Sales Inc hardware accompanying the Software Package will be free from defects in materials and workmanship under normal use and service for a period of six 6 months from the date of receipt or for the period of time indicated by the manufacturer of a specific piece of equipment whether that period is longer or shorter than six 6 months Any implied watranties on the Software Product or the equipment pieces are limited to these stated periods American Medical Sales Inc s entire liability and your exclusive remedy shall be at American Medical Sales Inc s option either a return of the price paid or b repair or replacement of the Software Product or hardware that does not meet this Limited Warranty and which is returned to American Medical Sales Inc with a copy of your receipt This Limited Warranty is void if failure of the Software Product or equipment has resulted from accident abuse or misapplication Any replacement of the Software Product or equipment will be warranted for the remainder of the original warranty period or thirty 30 days whichever is longer To the maximum extent permitted by applicable law American Medical Sales Inc disclaims all other warranties either express or implied including but not limited to implied warranties of merchantability and fitness for a particular
25. age is reviewed from a Review or WebVue station by an on call doctor it will not be marked as diagnosed These images will remain on the pending portion of the Diagnostic Workstation worklist When diagnosed on a Diagnostic Workstation perhaps at the on call doctor s home these images will move from the pending to the completed portion of all Diagnostic Workstations if desired Remember to be the on call doctor the on call selection box must be checked before the OK box is clicked during the doctor logon Co Permission to receive on call images is set on the COELLO Archive See the CQUCLLO Archive User Manual for instructions Form 330 4 001 Rev 05 Page 10 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual What the On Call System Does Once an image is designated on call by including on call in the accession field the Image Gateway of the COQUCLLO Archive creates an additional destination in addition to whatever other ones it would normally use for this image This additional rule is Send this image to the Web Server to hold in its on call box The Web Server will hold this image until a radiologist logs in as the on call doctor Once a doctor is logged in as the on call doctor the system will send all images being held as on call images to that doctor s viewing station ic IMPORTANT NOTE How images are routed to viewing stations is set up differently for each network
26. alling location date time and length of call Additional telephone support can be purchased in 5 hour increments Once your free telephone support has been exhausted or the warranty period has lapsed whichever comes first additional time can be purchased Contact AMS for current rates When contacting AMS with a service request the following items are required 1 CdCCLLO Service Contract number if applicable The specific time and COUTELLO component exhibiting the issue and the date time the issue arose 3 A full description of the issue as detailed as possible 4 When concerning a specific patient file the specific patient name and ID are essential for analysis 5 Contact information for a person at both the distributor and user sites who can speak to AMS personnel regarding the issue 6 Noncompliance with the above can will cause a delay in initiating a timely response To service your account remotely AMS personnel must have full time remote access to your network and all COUCLLO equipment This will help facilitate effective updating of software programs and resolving service requests Customers requiring service who have valid service contracts will be billed as per the service contract Customers without service contracts will be serviced only after acceptable financial agreements have been completed i e credit card authorization valid purchase order etc Please ask for current hourly billing rates Diagnostic
27. and hold left button and 2 Depress and hold left button and Activity Menu 1 Click on PAN in the Tool section of 1 Click on PAN in the Tool section of the Activity Menu the Activity Menu 2 Depress and hold left button and 2 Depress and hold left button and move cursor right or left move cursor up or down Once the trackball icon has changed to the PAN icon you can move the image using the left button and trackball without returning to the Activity Menu Controlling Pan Using Only the Trackball Holding the left button down and simultaneously moving the trackball so that the icon moves in the direction you wish to move the image will complete this function Wherever you grab the image that point will be the central point of adjustment The hand icon reduces slightly in size when you activate the pan movement Window Level Window and Level values can be adjusted on the fly with the trackball All options for Window Level are accessed from the Activity Menu Once the trackball icon has changed to the WINDOW LEVEL icon you can window level the images without returning to the Activity Menu Controlling Window Level with only the Trackball Holding the left button down and simultaneously moving the trackball so that the icon moves up or down changes the window values of the image The image will change as you move the icon Moving the icon up lowers the window number compresses the window which darkens the scre
28. ata and voice files from a transmitting COUCLLOA Workstation and the automation of much of the transcription process Completed work is pulled back via a digital network LAN WAN telecom web etc for verification distribution and storage Because COUCLLO Workstations operate under the DICOM file protocol patient study and physician information can be automatically populated in transcription reports saving much repetitive work COUCLLO Scribe s preset reports also provide total automation for issuance of standard normal reports using the MS Word macro system COUTELLO Scribe helps to automate non standard reports by allowing development of preset report templates that can be used in conjunction with voice transcription This can include use of complete standard negative reports or portions of commonly used sections for either normal or abnormal reports The transcriptionist has full control over the input editing and use of these preset report templates For more information call American Medical Sales or consult the Catella Scribe manual Form 330 4 001 Rev 05 Page 42 American Medical Sales Inc cate La Diagnostic Workstation User Manual CHAPTER 15 ACTIVITY MENU amp TRACKBALL CONTROLS Here is a comprehensive alphabetical list of the controls used by the Activity Menu and Trackball Command Description ANGLE Activates angle measurement tool CANCEL _ Terminates current operation CLEAR PATIENT INFOR
29. ch feature on the Activity Menu are found in Chapters 5 6 and 7 Keyboard Controlling the COtELLA Workstation rarely involves the computer keyboard The keyboard is only used in the following five situations 1 System start up When the computer is first turned on the Windows 2000 system will require keyboard commands Since COUTELLO is designed to be left on the typical user need not be bothered by system startup See Chapter 2 or your system administrator for more information Form 330 4 001 Rev 05 Page 6 American Medical Sales Inc CacCcL_L_a Diagnostic Workstation User Manual 2 Password The use of both the workstation and the COUCLLO software are password controlled Both of these passwords are entered via the keyboard or the optional fingerprint reader See your system administrator for more information 3 Remarks It is possible to enter remarks during the diagnostic process These remarks can be entered either by the keyboard or can be dictated See Chapter 7 for more information 4 Entry of set up parameters See Chapter 11 Options for more information This type of data is usually entered only once for both the institution and doctor This is another productivity feature of the COCCLLO Workstation 5 Typing annotations on the image Information Network COUCLLG provides communications capability to access sources of patient images studies and records The most effective way to do this is through a standard c
30. cludes all appropriate software documents and licensing documents for each software component Figure 1 A COUCL_L_O 2 Monitor workstation with an additional Navigation Monitor for RIS or 3 D The catcL__a Workstation Display COUCLLG Workstations typically use high resolution medical grade monitors for image display The standard monitor has a 2 mega pixel resolution 2MP Higher resolution monitors 3 or 5 MP or color monitors can also be ordered COUCLLOG displays images in a simple direct format This is done intentionally to maximize productivity The figure below illustrates display components on a one monitor workstation display configuration Thumbnail l Column Main Image Area Move Up or Down Thumbnail Column Activity Menn Figure 2 Location of display elements on a COtCLLA Monitor Main Image Area All images are initially presented in the correct aspect ratio and are enlarged to take advantage of as much of the monitor as possible in this area Form 330 4 001 Rev 05 Page 4 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Activity Menu All controls for the workstation are located here this is the default location This horizontal area at the bottom of the screen is divided into four general areas From left to right Window Level Controls Measurement and Stack controls Advanced Tools and Image Information Image Information includes such items as patient name patient ID number imag
31. configuration of the workstation It is very important that you set this file up correctly It is recommended that you have a staff member familiar with editing these types of files complete this work The figure below shows a typical doctors ini file Bill needs to check before final release Last Goody First Oscar Password olives Default Tool Window Display Multi False key SAMPLEO5 key Figure 37 Example of doctors ini file ic It is recommended that you make an electronic copy and a printed copy of this file once you have made your desired changes This will save you much time in the future should this file need to be reestablished Form 330 4 001 Rev 05 Page 53 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual 3D 24 A Activity Menu 5 6 12 Adding and Removing Users 37 Annotate 17 C Cancel 27 cateLLa SCRIBE 42 cateLLa Workstation 4 9 CD 20 Clear Patient 28 CONTACTING US ea Equalize 14 D Delete Mode 27 Diagnosis 30 DICOM 2 15 19 27 28 29 30 DICOM Print 8 DICOM Push 7 DICOM Query Retrieve 7 Digams ini File 51 Display 4 Display Configurations 32 34 Doctors ini File 53 E Flip Image 15 G Get Selected Images 29 H Hounsfeld Units 15 Form 330 4 001 Rev 05 Index Identification 37 IMAGE CONTROL TOOLS 12 Image Details 19 Invert 14 15 K Keyboard 6 L LICENSE 49 Locator Sel
32. dern radiology viewbox that just happens to be powered by a computer The keyboard is hidden because you rarely need to use it There are no CTRL ALT T type commands You use a trackball like that used with Ultrasound equipment or mouse The keyboard is only used in a few instances entering passwords if you aren t using the fingerprint reader typing remarks optional because you can use your voice and setting user options In the typical reading session the keyboard is never used Using the trackball s simple two button controls will give you the three most common digital imaging tools These three tools window level zoom and pan will account for up to 95 of the tasks you will perform in digital imaging Probably more than 99 of what you want and need to do is within one click For those who may want or need more tools they are available from an activity menu at the bottom of the screen While COUCLLO may appear simple it is supported by a very sophisticated software system that attains this look and feel Behind CQUCLLQ s simple face are all the powerful sophisticated tools that you may need Eliminating Icons Increasing Productivity COUCLLGO makes you efficient in numerous ways Since there are no industry standard icons we have minimized their use We have not made up symbols the translation of which you need to memorize By using simple plain words we eliminate the time consum
33. e date and time Your system administrator can modify the data displayed in this box Thumbnail Column The first image in each of the current patient s series is displayed vertically in this column This allows you to quickly understand the number of image sets needing review By clicking on one of these images that image set will be displayed in the Main Image Area If more series are available than can be displayed in this vertical area controls are provided to move up and down the column Trackball COUCLLO utilizes a two button trackball or mouse as its primary mechanical control method We highly recommend that a trackball be used instead of a two button mouse as the trackball limits hand and arm movement Typical users report that it takes about one week to become completely comfortable with a trackball Medical professionals who operate ultrasound equipment will already be familiar with this device Not assigned Left Button Control Function ani eae 9 EN Right Button Select command Trackball function Zoom Roller Pan Window Level Stack Control Figure 3 Trackball components With the trackball you can easily control the four major tools of digital imaging zoom pan window level and when appropriate for the image set stack control In addition the trackball is used to move the cursor to any monitor When you log in to COUCLLG a predetermined primary tool will be assigned to the trackball It may b
34. e patient images to a DICOM printer either film or paper Form 330 4 001 Rev 05 Page 8 American Medical Sales Inc cate La Diagnostic Workstation User Manual CHAPTER 3 STARTING THE catea WORKSTATION Powering Up the CaccL_a Workstation To power up the computer push the power on button on the front face of the computer This may be a momentary type switch commonly found on server type computers It may have to be held in the in position for several seconds before the computer turns on This is a safety feature and not a cause for concern The use of a momentary on off switch helps to prevent accidental shut off of the computer There are also individual ON switches on each monitor Make sure each of these switches is also in the ON position Cs It is highly recommended that the CQUCLLO Workstation be plugged into a Universal Power Supply UPS so that battery power is available to properly shut down the workstation in case of a general power failure in your facility The UPS will also help assure a cleaner source of power for the workstation ic WARRANTIES AND SERVICE PLANS ON catcllLa EQUIPMENT AND SOFTWARE DO NOT COVER DATA LOSS OR CORRUPTION OR CLAIMS LIABILITIES DAMAGES COSTS AND EXPENSES RELATING THERETO INCLUDING CHARGES FOR RECOVERY OR ATTEMPTED RECOVERY OF DATA WHETHER SUCH LOSSES ARE CAUSED BY POWER SURGES VIRUSES IMPROPER HANDLING OR FAILURE OF EQUIPMENT AND HARD DRIVES OR ANY OTHER CAUSE NOR D
35. e to capture images from a variety of manufacturers film scanning and digitizing devices COUCLLO Scan temporarily stores these images for transmittal via network communications to storage or viewing devices Other than to check the basic quality of the image and positioning COUCLLO Scan is not intended to be used to display the images COUCLLO Scan is not a diagnostic viewing station and should not be used as such COUCLLO Scribe is an enabling software and hardware device that allows the receiving of voice and text transmissions from other computer systems Designed to work in conjunction with COUCCLLO Workstations COUCLLO Scribe displays and plays received messages These messages can be stored but COUCLLG Scribe is not intended to act as the permanent archive of this information COUTELLO Scribe can receive physician specified patient image files in jpg format for purpose of inclusion in reports It is not Form 330 4 001 Rev 05 Page 47 American Medical Sales Inc cate La Diagnostic Workstation User Manual intended to be used to display images COUCLLO Scribe is not a diagnostic viewing station and should not be used as such These devices can be a software and hardware component in a complex and layered computer hardware and software system which provides storage display and network communications for medical practitioners at various levels of decision making This manual is not intended to be a definitive explanation of thi
36. e zoom or window level This may be different for each doctor See your system administrator for more information The trackball screen cursor will indicate which control function is currently active See the figure below for icon definitions W L Figure 4 Zoom Pan Window Level and Stack Control Icons Controlling Zoom Holding the left button down and simultaneously moving the trackball so that the icon moves towards the top of the screen will zoom the image to a larger size Holding the left button down and simultaneously moving the trackball so that the icon moves toward the bottom of the screen will zoom the image to a smaller size Form 330 4 001 Rev 05 Page 5 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Controlling Pan Holding the left button down and simultaneously moving the trackball so that the icon moves in the direction you wish to move the image will complete this function Note that the hand icon reduces slightly in size when you activate the pan movement Controlling Window Level Holding the left button down and simultaneously moving the trackball so that the icon moves up or down changes the window values of the image The image will change as you move the icon Moving the icon up increases the window number which lightens the image Moving the icon down decreases the window number which darkens the image Holding the left button down and simultaneously moving the trackball so t
37. ect 21 Logging Off 40 Logout 20 29 Loop 33 34 Main Image Area 5 Monitor Control 12 Move Resize 22 O OK Next 30 On Call 10 11 Optimize 14 Overlay 21 P Pan 5 6 12 13 Passwords 9 Prefetch 25 Preset Value 14 Print Image 20 Q Quad Display 21 Query 28 Query Patient Level 29 Query Retrieve 27 R Remarks 30 Reset 14 15 Rotate 15 Run 32 34 S Scan Stations 41 Select Mode 26 Shutdown 40 Shutting Down 40 Slider Bars 14 Sortable Worklist 26 Stack Control 5 6 Stack Viewing 32 34 Stop 33 34 Support 45 Sync 33 34 T Thumbnail Column 5 Thumbnails 19 Tools 38 Trackball 5 U Up Query Level 29 V Verify 31 W WARNING MESSAGES 44 Window Level 5 6 12 13 14 15 38 Worklist Management 15 Z Zoom 5 6 12 32 34 Page 54
38. en Moving the icon down increases the window number expands the window Holding the left button down and simultaneously moving the trackball so that the icon moves to the right or left changes the level value of the image The image will change as you move the icon Moving the icon to the left increases the level value Moving the icon to the right decreases the level value Moving the icon in a diagonal direction will change both the window and level values as indicated in the chart below Level Value Right and Up Higher Higher Icon Movement Window Value Right and Down Lower Higher LeftandUp Higher ____ Lower Left and Down Lower Lower Advanced Window Level Options Advanced WINDOW LEVEL features may be selected from the Advanced WINDOW LEVEL Option Box See the figure below Its default location is to the left of the Activity Menu Form 330 4 001 Rev 05 Page 13 American Medical Sales Inc cartela Diagnostic Workstation User Manual Use File Values Soft Tissue Figure 9 Advanced WINDOW LEVEL Option Box Manual Control using Slider Bars Use the trackball cursor to move the slider bars up or down to increase or decrease the respective values The numerical interpretation is displayed at the center bottom of the window Select Preference Value CaUCLLO allows each doctor to set preset values for each imaging modality CR CT MR NM RF US XA See Chapter 10 on how to set these values If preset
39. er Manual Lappen David Perry Greg ZDental Demo ShutDown Figure 6 Individual User List Box A second password screen will now appear Type your password and press the ENTER key If you have a fingerprint reader you may have the computer verify your identity by putting your finger over the reader Enter Password OK Shutdown On Call Figure 7 COUCLLO Password Box Your patient s first images will immediately appear and you can begin your interpretative work On Call Status Radiologists who have been set up with the permission to receive on call images will see an on call checkbox on their log in screen see the figure above To receive on call images a physician places a check mark on the on call checkbox and then logs in using their password Once the physician has logged in as the on call physician all on call images that have not been delivered to the previous on call physician will be automatically sent The on call feature is designed for use with CQCCLLO Review Workstations and COLELLO WebVue Stations but the on call box will appear on the CAUCLLO Diagnostic Workstation login because there are some circumstances where it is useful see below The on call feature functions similarly to wet reads It is not designed for completing interpretations and diagnostics If the physician wants to complete interpretation a workstation with the COUCLLG Diagnostic Software should be used After an im
40. es Inc CaCc_L_a Diagnostic Workstation User Manual CHAPTER 13 catcLLa Scan Station COUCLLO Scan Stations operate on standard Windows 2000 operating systems Each station includes a medical grade film scanner computer communications capability color monitor mouse and keyboard Each station s communication package is configured during the installation process to meet the requirements of the specific applications and may be configured to encrypt images for transmission over the Internet The appropriate COUCLLO software components are preinstalled on the system along with other necessary software The installation package includes all appropriate software documents and licensing documents for each software component The figure below shows the CQUCLLA Scan Station Figure 35 Basic Components of a COQUCLL_O Scan Station COUCLLG Scan allows you to automate the film scanning process for up to 50 films at one time More importantly COUCLLA Scan will format films into the DICOM standard automatically with all required header information For more information call American Medical Sales or the consult the Catella Scan manual Form 330 4 001 Rev 05 Page 41 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 14 catcLLa SCRIBE About cateLLa Scribe The other side of COUCLLO Workstation s dictation system is COUCLLO Scribe The COUCLLO Scribe System allows for the receipt of digital d
41. f Display of Image Details on a Monitor eeeeeccccceeeeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 19 Fieu 17 gt Printer Selection Scr eia a a eee ie ec eee cea 20 FPSUES o Ouid Dip cxicas tre saast ese a tease sts anem atiaed nets 21 Figure t L caorselechiomeura a a a espe a swine ai a ieeans 22 Figure 20 Examples of how MOVE RESIZE functions ccccccccccccceccceeeeeeseseeeeseeeeeeeeeeeeeeeeeeeeeeeeeeeeees 23 Fieu 21 WOM ics bs sep act set aa tas ya Se sense sate Uavaus baling Se sea sain a ioe Seana 25 Fiere 227 QUe y WAM GOW siena aa aT EAE E EE NEE AUE E AT 28 Figure 23 Query Window returned with Patient Level Information cccecceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 29 Preure 24 Remarks WINdOWiersrinia irua o TAE EEE E NEA EEE 3 Freure 25 Repot V eri IC all OM SCTE CM onasin n eE E T E E E TT 31 Fiare 20 Sack VIEWIN NOG ainina EEEE EE EEE E EE E 32 Peor 27 Denio Stack CONTOS nnna E N E ia sedie a aesaeeacee 33 Fig re 28 Typical MPR screen presentation 3 sacshsasasasiasstaashiasnsaveiviviisesieteeeannniaeaeeeamnenena duces 35 Teire V AGIMIMIS LALLY CRA eii E EE N E eaeaanideiacae 37 Feared denu icaton 1 a Daoin E 37 ere o e o Da E E E E E Meueasnpsteateeetect 38 Ficure o2 Window Level PCC CNG Coats eremscaa deat osdewseetieadieasGemeuomusaedeateaseastueaoddeasGowenetuesseuathdonanadeenseatocesecd 38 retire oo DICOM Transit Tabure n e a e E 39 Figure A COW Glu Or PAD A E E E E E A E E A 39 Figur 35 Bas
42. h requests without knowing which doctor will read the images the choices are for all doctors using the COUCLLO workstation Images generated within the last 24 hours will NOT be automatically retrieved from the archive in a prefetch They should already be on the COUCLLO workstation that generated the prefetch request The information that controls the type of prefetch that will be conducted is located in the digams ini file To modify this please contact your system administrator Prefetch may be set as follows ALL Returns all previous images Form 330 4 001 Rev 05 Page 25 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual MRS Returns the most recent studies where is a single digit that indicates how many studies to return LMO Returns the most recent studies with the same modality where is a single digit that indicates how many studies to return Sortable Worklist When a case is diagnosed the patient s name will move from the Pending Patients Worklist to the Completed Patients Worklist You may view images from the Completed Patients Worklist as well After a few days patients names will be automatically moved from the Completed Patients worklist to a Local Archive on the COUCLLO workstation This allows fast access to recent images but keeps the information on the worklist manageable After a few more days the number is determined by settings for your site the images a
43. hat the icon moves to the right or left changes the level values of the image The image will change as you move the icon Moving the icon to the left decreases the level values Moving the icon to the right increases the level values Moving the icon in a diagonal direction will change both the window and level values as indicated in the chart below Icon Movement Window Value Level Value Right and Up Higher Higher Right and Down Lower _ Higher Leftand Up Higher Lower Left and Down Lower Lower Controlling Stack Holding the left button down and simultaneously moving the trackball so that the icon moves right will sequentially display images with higher numbers Moving the icon to the left will display the images in the stack with lower numbers ic As you move the cursor from one monitor to another you may find that the control icon changes COUCLLG remembers the last control function used on each monitor and returns to that function This is another way COUCCLLO increases your productivity Switching Functions To switch between Zoom Pan Window Level and Stack Control simply CLICK on the right button The icon will change to a new function The order of change is Zoom to Pan Pan to Window Level Window Level to Stack Control Gf available for the images being displayed otherwise to Zoom and Stack Control to Zoom Activity Menu The Activity Menu default location is along the bottom of the screen Complete descriptions of ea
44. he pending portion of your worklist See Chapter 6 for more details on the worklist DICOM Query Retrieve COUCLLO interacts with databases at your institution through a DICOM compliant Query Retrieve interface This interface knows how to translate your requests for information into a form that the database understands The database knows how to transfer your requests to COCCLLO In some cases this interface is provided by your institution in some cases by another manufacturer s component and in some cases by American Medical Sales See Chapter 6 for more details on operating COELLO s DICOM Query Retrieve feature Form 330 4 001 Rev 05 Page 7 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual Other Databases COUCLLO also has the ability to manage non DICOM image files In teleradiology applications it is common to store and send images in other file formats such as JPEG TIFF or BMP Legacy systems operating on proprietary software systems usually do not adhere to DICOM standards American Medical Sales can help you with these special conditions so that COUCLLO will work in these environments In some cases institutions also wish to integrate their HIS and RIS systems with their image viewing solutions If desired COUCLLO may be integrated with your system Contact American Medical Sales for further information and assistance DICOM Print COUCLLO supports DICOM Print This allows users to print th
45. hould be forwarded to American Medical Sales Inc at the following address current as of 2005 confirm address before mailing American Medical Sales Inc Installation Records 4928 West Rosecrans Avenue Hawthorne CA 90250 6619 United States of America Our authorized representative is CEpartner4U Esdoornlaan 13 3951DB Maarn The Netherlands Tel 31 0 6 516 536 26 Form 330 4 001 Rev 05 Page 48 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 19 LICENSE AGREEMENTS The SOFTWARE PRODUCT is protected by copyright laws and international copyright treaties as well as other intellectual property laws and treaties The Software Product is licensed not sold The Grant of License grants you the right to use one copy of the Software Product on one computer If the computer is connected to a network this License does not allow you to use the Software Product on other computers on the network You may not reverse engineer decompile or disassemble the Software Product except and only to the extent that such activity is expressly permitted by applicable law notwithstanding this limitation Except as noted above the Software Product is licensed as a single product Its component parts may not be separated for use on more than one computer American Medical Sales Inc is not obligated to provide any party with the source code of any Software Products Resellers may sublicense the Software Produc
46. ic Components of a COUCLEG Scan Sta ON sienien aa aaa aaa 4 Picure 36 Example Of lirst part of Cig amis Imi iile sierica iasudeesdioas GonenetedeateossGivewtecdtorausiGeneneed 51 Pictire 37 Example Of doctors niTer arao a are o a ae 53 Form 330 4 001 Rev 05 Page v American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 1 INTRODUCTION Thank you for selecting COUCLLO as part of your healthcare information enterprise solution CaOLCLLG Advanced Digital Products offer full featured digital medical image viewing and communications The basic design criteria after assuring high quality images are ease of operation and simplicity of design that allow the health care professional to smoothly move to digital image reading without hesitation or resistance COUCLLO Workstation products focus on the final part of the process of medical imaging diagnosis and reporting and are key to increasing the productivity of the healthcare professional Indications for Use The CaUCLLO Diagnostic Workstation Version 4 0 is a medical image and information management system that allows easy viewing selection processing printing telecommunications and media interchange of multi modality medical images from a variety of diagnostic imaging systems The CaUCLLG PACS interfaces to various storage and printing devices using DICOM or similar interface standards The system is available for diagnostic and non diagnostic workstat
47. ic Workstation User Manual CHAPTER 8 MULTI FRAME IMAGES Setting Display Configurations You may select how you wish to view image series Image series can be viewed in 1 up or Quad two over two All imaging tools function with either configuration COUCLLO automatically adjusts the zoom factor of the images to take advantage of the monitors full viewing area Basic Image Controls Same as Others When viewing multiple image files all the same basic image controls are available These include Zoom Pan Window Level Invert Rotate Flip Image Measure and Reset In addition loop viewing and image scouts with line locators are available for MR and CT images Stack Viewing All images on this version of CQUCLLG are presented in the stack mode A series of MR images are shown below in the Quad Display mode Note that the scout image is shown in the lower right corner of each frame together with reference lines for the individual image s you are viewing Figure 26 Stack Viewing Mode The following tools are available for stack viewing Zoom Enlarges the image Note that the percentage factor is listed next to the Zoom command see figure below Run Begins automatic stack viewing The length of time an image is displayed is controlled by slider bar below Form 330 4 001 Rev 05 Page 32 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Stop Halts the automated stack viewing The RUN
48. indow Level The Window Level function changes these values for the image displayed on the active monitor See Chapter 4 for details of how to access this function using the Activity Menu Measure COUCLLG allows you to measure distances and angles for any image Measurements in Hounsfeld Units are also available for MR images If the DICOM file has measurement calibration information COCCLLA will allow you to begin measurement processing directly If you wish to activate either the angle or Hounsfeld Units function click on the appropriate option in the Measure box on the Activity Menu See the figure below Form 330 4 001 Rev 05 Page 15 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Measure Distance C Angle Hounsteld Units Figure 10 Measure Method Selection Box If measurement information is not sent with the DICOM file COUCLLO will ask that you calibrate distance before conducting a measurement Use something of known size 1 e a label An information box similar to the figure below will appear ARNING All measurements for this image will be based on this setting Try to keep the line either horizontal or vertical Horizontal and Vertical spacing assumed equal Draw tine Cancel Figure 11 Length Measurement Information Box To draw a measurement calibration line select a location on the image press and hold down the left trackball button and while holding
49. ing mental translation step to speed up your reading session In another example we have pioneered the concept of the customizable screen and Activity Menu which allows you to configure the viewing area to your preference This helps reduce the need to divert your eyes from the images during your interpretative work DICOM Compliant COUCLLG Workstations comply with the DICOM 3 0 standards DICOM stands for Digital Imaging and Communications in Medicine It is an evolving standard developed by a wide group of international radiology healthcare professional organizations such as the American College of Radiology Radiological Society of North America European College of Radiology etc software and hardware medical and computer equipment manufacturers and other interested professionals Conformance to this standard assures you that COUCLLO products will fit easily into pre existing medical imaging networks or networks now being planned for implementation It also assures easy connection to other manufacturers DICOM compliant equipment Occasionally device specific variations in modalities will require some intervention or adjustment You should confer with your system s administrator so that they can contact the responsible vendors to discuss the related issues Contact American Medical Sales Inc for the latest version of the COUCCLLO DICOM Compliance Statement If you are contemplating using non DICOM compliant equipment in your system
50. ing systems that create DICOM output With proper links the COUCLLO Workstation also can invoke FDA cleared third party image processing systems for advanced image processing such as 3D display It can also access RIS and HIS systems and can be used to review patient information The catala Diagnostic Workstation Version 4 0 is not intended for use for primary diagnostic interpretation of mammographic images Effective use of the CaUCLLGQ PACS requires adherence to modality imaging protocol requirements and the imaging manufacturers instructions regarding maintenance and calibration of the modality imager Patients must be instructed to avoid movement during their imaging exams to minimize misregistration of images Achieving satisfactory registration will contribute to optimizing the performance of the CAUCLLA PACS COUCLLO s measurement accuracy is limited to modality imaging system accuracy and site specific imaging techniques All digital images and associated data displayed by this device are presented for the interpretation of the health care professional as is any image or patient information All medical professionals and personnel using COLTELLO must be trained in the use of the device by American Medical Sales or by an authorized COCCLLO dealer COUCLLO Scan is an enabling software and hardware device that allows the digitization of film images CQUCLLO Scan software includes other manufacturers image grabbing softwar
51. ion factors used in saving these images to your reports The write resolution window indicates whether bits are to be skipped in the saving process Compression makes the image file size smaller but it is lossy compression meaning that image information is lost Physicians can try various settings to determine their preference for the output quality they need for their referring physician reports and output files Remember these resolution and compression selections do not affect the images saved on the archive only the images used in your reports and images saved to files for other non diagnostic work Annotation is not saved to the archive ee ee ic If you change the file name the image will be saved as a jpg file under the name you give it This will allow you to manipulate the image in other computer programs such as teaching files If you do not change the name the file automatically will be picked up by the Catella Scribe system You can delete any of the annotations simply by highlighting them and pressing the DELETE button Save as DICOM Saves image in DICOM format Form 330 4 001 Rev 05 Page 18 American Medical Sales Inc cate La Diagnostic Workstation User Manual Thumbnails Figure 15 Thumbnail Column shown on left side of screen The Thumbnail Column gives you a quick idea of how many series of images are available for the patient on your workstation As seen in the figure above all image
52. ions including workstations designed as web based remote viewers or CD viewer workstations The software may be installed as a PC based stand alone system a software application a web based or SDK format and is designed to be integrated with various DICOM compliant OEM systems The Catella PACS displays stores prints and telecommunicates images from a number of medical modalities including but not limited to MR CT DR CR X ray Angiography Ultrasound or digitizers The CQUCLLO Diagnostic Workstation Version 4 0 performs other user defined post processing functions such as multi planar reformatting of images The CQUCLLO PACS can display processed data from certain FDA cleared third party image processing systems that create DICOM output With proper links the COCCLLO Workstation also can invoke FDA cleared third party image processing systems for advanced image processing such as 3D display It can also access RIS and HIS systems and can be used to review patient information The catala Diagnostic Workstation Version 4 0 is not intended for use for primary diagnostic interpretation of mammographic images Key Concepts Images can be generated anywhere throughout the healthcare enterprise With the exception of mammography COUCLLO Workstations are designed as primary diagnostic stations which can be added to your existing digital imaging network such as a PACS system tied directly to digital modalities MR CT DR CR or digit
53. izers or used as part of a teleradiology solution Any type of digital image can be displayed including CT CR DR MR X Ray Angiography Ultrasound etc With proper links COUCLLOG can also access RIS and HIS systems and can be used to review patient information The CAUCLLG Workstation is an intuitive system It is operated by a two button trackball or mouse Easy to learn it is even easier to use COUCLLO operates under the Windows 2000 operating system using standard graphical user interface techniques Icons are kept to a minimum to avoid confusion as there are no standards between medical equipment interfaces COUCLLO is designed to allow you to transition from film screen reading techniques to digital diagnosis easily and efficiently CQUCLLQ s unique operating methods allow you to be as productive or more productive than you are today while gaining the benefits of digital images You want the clearest image possible presented in a way that keeps your attention on your diagnostic work With the CQUCLLOA system your workflow is as intuitive in the digital environment as it has always been in the film setting Form 330 4 001 Rev 05 Page 1 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual Power of Digital without the Complexity of Computing Did you notice that it s hard to find the computer and the keyboard Again this is intentional We want you to think of COQUCLLO as just the latest most mo
54. k line ends this section Cat 1 line 1 is Friendly name as registered on Gateway 192 168 0 24 line 2 is Gateway IP address 12222 line 3 is Gateway Dynamic address port Date Format US is MM DD YYY EU is DD MMM YYYY US Promote Small Images Should we promote 256 by 256 images to 512 by 512 No No Activity Time Out HIPAA when nothing happens log out 20 minutes Image Server Info where to get images from CATWSI1 AE Title of calling application 10 10 10 9 Host Name for Image Server or TCP IP address 36872 use 106 for Dicom Q R CATELLA PROPRIETARY image server manufacturer ACME_STORE Called AE Title Image Server AE Title 36873 TCP IP Push Port only for Proprietary or NONE 36877 gt Push Port can be marked Archived Move DICOM information on DICOM MOVE receive engine ACMEI AE title to find MOVE engine 10040 MOVE port Figure 36 Example of second part of digams ini file Cos It is recommended that you make an electronic copy and a printed copy of this file once you have made your desired changes This will save you much time in the future should this file need to be reestablished Form 330 4 001 Rev 05 Page 52 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual APPENDIX B DOCTORS INI FILE The doctors ini file located in the C AMS Cat4 DataElements folder contains information about the doctors preferences and options related to
55. k mode Method Enlarge Image 2 Shrink Image Trackball 1 Click on the right button until Zoom Icon 1 Click on the right button until Zoom gt appears Icon appears 2 Depress and hold left button and move 2 Depress and hold left button and cursor up move cursor up Activity Menu Click on ZOOM in the Tool section of 1 Click on ZOOM in the Tool section the Activity Menu of the Activity Menu Depress and hold left button and move 2 Depress and hold left button and cursor up move cursor down Once the trackball icon has changed to the ZOOM icon you can enlarge and shrink the image using the left button and trackball without returning to the Activity Menu Controlling Zoom Using Only the Trackball Holding the left button down and simultaneously moving the trackball so that the icon moves towards the top of the screen will zoom the image to a larger size Holding the left button down and simultaneously moving the trackball so that the icon moves toward the bottom of the screen will zoom the image to a smaller size Form 330 4 001 Rev 05 Page 12 American Medical Sales Inc CaCCcL_L_a Diagnostic Workstation User Manual Pan Once the image is enlarged beyond the monitor s ability to show it in its entirety you may wish to move the image to a new area of interest Trackball 1 Click on the right button until Pan 1 Click on the right button until Pan Icon appears Icon appears 2 Depress
56. lease Delete Some Patients If you do not know how to do this see your systems administrator The bottom section of the worklist provides other user functions These are described below To select a patient case to view use these commands Select Mode When in the Select Mode the Worklist can be used to call up patient images The title on the top of the Worklist indicates the mode Select or Delete Method Viewing Cases using the Worklist Activity Menu 1 Click on WORKLIST on the Activity Menu 2 Click on name of patient to view case Form 330 4 001 Rev 05 Page 26 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Cancel The cancel button is used to close the worklist window Method Close Worklist Window Activity Menu Click on CANCEL Delete Mode The COUCLLO Workstation deletes cases from your worklist in two ways First COUCLLO will automatically remove all cases that have moved to the Completed Patients worklist after a given period of time See your system administrator for details Second cases can be deleted manually Manual deletion should not normally need to be done To manually delete a case click on the DELETE MODE button Note that the button will now say SELECT MODE Clicking on the SELECT MODE button will return the Worklist to the select mode Next click on the patient s name A confirmation window will appear To confirm your desire to delete this case click on DELE
57. ll other trademarks trade names products or services are registered trademarks of their respective companies Form 330 4 001 Rev 05 Page 50 American Medical Sales Inc cate La Diagnostic Workstation User Manual APPENDIX A DIGAMS INI FILE The digams ini file located in the C AMS Cat4 DataElements folder contains information about the system you are using the locations of the equipment from which you wish to receive images and send dictation files and options related to configuration of the workstation Itis very important that you set this file up correctly It is recommended that you have a staff member familiar with editing these types of files complete this work Below is a typical digams ini file 1 this computer s id for locking diagnosed messages 2 Number of screens 1200 pixel width of single screen 1600 pixel height of one screen linear configuration is rectangular or linear 1 days autodelete age cutoff number followed by hours or days 5 days Local archive for x days NONE no archive 3052565 Admin 600 seconds with Echo test pending before reset StoreSCP gt 0 NONE Host Name for RIS system for Reports HL 7 or TCP IP address NONE RIS Server HL 7 Port Display Fields enumerate display fields desired 0010 0010 patient name 0010 0020 patient id 0010 0030 patient birthdate 0008 0020 Study date 0008 0090 referring physician 0008 0080 institution name
58. mpler avoiding duplicate data input and greatly speeding your dictation process See your system administrator for exact details as to how the REMARKS feature works on your network Form 330 4 001 Rev 05 Page 30 American Medical Sales Inc CaCCcL_LL_a Diagnostic Workstation User Manual Note that specific patient information appears on the Word template This comes from the DICOM record Click on the OK button when your remarks are complete COUCLLG allows you to enter and edit both typed and dictated remarks for a single patient if you wish Dictation is controlled by the four buttons and a slider control in the DICTATION box at the lower right of this window Verify Your transcribed dictation can be redirected to a COCCLLO Workstation for electronic verification Figure 25 Report Verification Screen The figure above shows a displayed report as it would appear on your workstation The report can be accepted as presented or corrected To accept the report CLICK on ACCEPT REPORT To type corrections to the report move the cursor to the desired location on the screen and type using the keyboard To dictate changes to the report press the foot pedal and dictate the changes If there are verbal corrections CLICK on CORRECTIONS and the transcriptionist will get your comments to add to the document When the report is correct CLICK on ACCEPT Form 330 4 001 Rev 05 Page 31 American Medical Sales Inc CaCcL_a Diagnost
59. n Tools Prelunnres Modality Settings for Computed Radiography CR Us Here yraa Levvel CT AS pe MRE XA NM EF Window howe Up Add Hawe Dern Modily oR Stutdown Log Ont Figure 32 Window Level Preferences COLELLO allows you to establish preset window and level preferences for each of eight modalities In addition you can give each preference a unique description These will appear when the Window Level Tool Window is used Modality Abbreviation Full Name AS Angioscopy CR Computed Radiography CT Computed Tomography MR Magnetic Resonance NM Nuclear Medicine RF _ Radio Fluoroscopy US Ultrasound XA X Ray Angiography Form 330 4 001 Rev 05 Page 38 American Medical Sales Inc CaCCcL_L_a Diagnostic Workstation User Manual To enter preferences first select the modality then enter the name window value and level value for each preference These are user specific preferences and not applicable across the institution DICOM Transfer This tab is used to select the DICOM header information that will appear on the monitor There are eleven elements to select from In addition this tab can be used to reset the DICOM receive engine and to test connectivity to the Scribe or other system Contact your system administrator prior to using this tab Identification Dicom Fields to Display E Patient Name Accession Number Institution Name Patient ID r Study Date m Patient Location
60. n will be grayed out In some instances the original images allow for reconstruction but with less than optimal MPR views In these cases COUCLLO displays a warning but still allows for MPR ic The quality of reconstructed images depends on a number of factors many of which are beyond the control of the MPR function It is therefore important that neither treatment nor diagnostic decisions should be based solely on the results of MPR analysis ic All notes and cautions regarding the COUCLLOG MPR function apply equally to information exported from this product for example a CD or printed report Users should ensure that recipients of this information are familiar with the notes and cautions supplied here Form 330 4 001 Rev 05 Page 36 American Medical Sales Inc cartela Diagnostic Workstation User Manual CHAPTER 11 OPTIONS This area should only be used by the system administrator to add users and to set preferences for oo ee Tools Administrative DICOM Transfer Administrative Password these users Administrative Hew Doctor atingi copied Fom ther Doctor Log in under new Doctor to change hore pirg Figure 29 Administrative Tab Adding and removing a user is a system administration function A special tab is provided for this work and a special password is required When a new user name is added and confirmed all settings of the current user are copied to the new user s profile When a pass
61. ns at the Bottom OK Closes the Options Window Log Out Ends the reading session returns the workstation to the COUCLLO logo screens but keeps the workstation ready for another user log in Form 330 4 001 Rev 05 Page 39 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 12 END OF SESSION CC Under normal circumstances end your session with the Log Out command Logging Off The Logout command can be selected from a number of different locations These include the Activity Menu the Worklist window and the Options window The Logout Command ends the reading session returns the workstation to the COUCLLO logo screens but keeps the workstation ready for another log in is COUCLLO should always be left on and not shut down This will allow the workstation to receive incoming images and to process them If the COQUCLLO Workstation is shut down images will be received only when the workstation is turned on The accumulated images that should have been sent to the workstation may take significant time to load and process Cs Logging out cancels that doctor s on call status WHEN A PHYSICIAN S ON CALL ROTATION ENDS THE DOCTOR SHOULD MAKE SURE THAT ALL NEW IMAGES HAVE ALL BEEN RECEIVED AND THEN LOG OUT OF THE SYSTEM SO THAT NO IMAGES WILL BE SENT TO HIM HER Shutting Down The Shutdown command can be selected from the Doctor Log In window Form 330 4 001 Rev 05 Page 40 American Medical Sal
62. o your transcription system without you having to enter the same information repeatedly COUCLLG when properly interfaced with your RIS HIS or transcription system makes the issuance of a normal report as simple as two trackball button clicks See your system administrator for exact details as to how the OK NEXT feature works on your network Assuming the OK NEXT feature is integrated into your network here are the commands Method Issuing a Normal Report Activity Menu Click on the OK NEXT button As a default set up the OK NEXT button will _ be disabled if not all images have been reviewed Your institution may wish to handle this differently Contact your system administrator If CAUCLLO Scribe is part of your network the OK NEXT command can send a complete report to your transcription station where preset reports can be added See your system administrator and the COUCLLO Scribe manual for details Remarks If an abnormal diagnosis is necessary you can use CQUCLLO to record your dictated or typed comments Simply press the footswitch and COELLO will capture your voice dictation to send to transcription Editing is accomplished through the REMARKS window See the figure below Since the DICOM image already has the pertinent patient information you should not need to reenter or repeat this information COUCLLO when properly interfaced with your RIS HIS or transcription system makes the issuance of an abnormal report much si
63. omputer network or an existing PACS COUCLLO operates over an Ethernet network 10 100 1000Mbps The operation of CAUCLLG is independent of the underlying communications technology Connections between the COUCLLO Workstation COCCLLOA Scribe CAOCCLLO Scan Catella Archive and other network equipment are regulated through the use of TCP IP addresses and ports Databases Database is computer language for source s of patient images studies and records Typically each institution will have many of these and each will contain some critical component of the patient record Unfortunately these are too often inaccessible and require complex and arcane user interactions COUCLLO can be configured to eliminate this problem and the confusion that comes with it by acting as a database access mechanism and by providing a single simple user interface American Medical Sales information systems vendors and your institution s networking professionals will work to eliminate unnecessary complexity by using COUCLLO as the platform to provide easy access to all of your institution s patient records systems DICOM Push There are a number of ways a workstation can receive image data under the DICOM standard In a PACS environment the most common way is for the PACS software to send images to the workstation This is called a push function COUCLLO is a DICOM Push compliant product Once images are pushed to the workstation they will appear on t
64. on User Manual Quad Display COUCLLG allows you to easily reconfigure the layout to display multiple series on one screen Simply click on the Quad Display button The Main Image Area will automatically divide into four equal viewing areas The first image of the first four series will be loaded into each area The active quadrant will be outlined in red To designate a quadrant as active move the cursor into the quadrant and left click This new quadrant will now be outlined in red Figure 18 Quad Display Also note that for studies that include scout images the scout image for each series appears in the lower right corner of each frame with locator lines Method Quad Display Activity Menu Click on Quad Display on the Activity Menu Cos When the Quad Display is activated the button label resets to SINGLE IMAGE Press this button to deactivate Quad Display Overlay Text Overlay allows the doctor to see some of the modality s settings i e mag strength slice thickness etc Method i Overlay Activity Menu Click on Overlay on the Activity Menu Locator Select Allows the user to manually select a more relevant image to use as the scout image Form 330 4 001 Rev 05 Page 21 American Medical Sales Inc CaCCcL_L_a Diagnostic Workstation User Manual To select a new scout click on LOCATOR A selection of new possible scout images along with relevant DICOM data will appear along the top edge of the moni
65. p image area has been enlarged to take up the full width of the screen and on the right is a Thumbnail Column moved to the center of the viewing area Note the Thumbnail Column can be moved right or left but it cannot be resized Figure 20 Examples of how MOVE RESIZE functions Form 330 4 001 Rev 05 Page 23 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual 3D The COUCLLO Diagnostic Workstation optionally supports 3D imaging When viewing a study you may press the 3D button to invoke 3D viewing for this image set In most installations the third party 3D package will be installed on the COUCLLO Diagnostic Workstation so that you may use the same mouse and keyboard controls to operate the 3D program The 3D software may be viewed on a dedicated monitor usually a color monitor Simply move the cursor from the COUCLLO image screen to the 3D screen to operate the 3D software Form 330 4 001 Rev 05 Page 24 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual CHAPTER 6 WORKLIST The worklist displays the names of patients whose images are pending to be read as well as those whose images have been read The figure below gives an illustration of a typical worklist COUCLLO lists patient name number of images for this case and the imaging modality If there are more cases than can be listed in the assigned space a scroll bar will appear to the right of each section Catell
66. purpose with regard to the Software Product the accompanying written materials and any accompanying equipment Form 330 4 001 Rev 05 Page 49 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual To the maximum extent permitted by applicable law in no event shall American Medical Sales Inc or its suppliers be liable for any damages whatsoever including without limitation special incidental consequential or indirect damages for personal injury loss of business profits business interruption loss of business information or any other pecuniary loss arising out of the use of or inability to use this product even if American Medical Sales Inc the supplier or the buyer has been advised of the possibility of such damages In any case American Medical Sales Inc and its supplier s entire liability under any provision of this agreement shall be limited to the amount actually paid by you for the Software Product and equipment Cs The License Agreement applicable to your product is located on the COUCLLO software accessible in the Options area The wording may differ from the wording in this manual Copyright 1998 2005 by American Medical Sales Inc All rights reserved American Medical Sales AMS catella CaCCLLA Scan and Catella Scribe CaLCCLLa Reports Image Armor CotCCcLLOVue cCatWeb Activity Menu and Audio Attendant are trademarks of American Medical Sales Inc A
67. re automatically deleted from the Local Archive also ic COUCLLO s straightforward worklist design has a purpose It increases your productivity Keep in mind that the more information displayed the more time you will spend reviewing it Limit your worklist information to the bare minimum necessary Remember that you can always bring up DICOM Image Details if you need more information You may also sort the worklist You can sort by any of the columns shown As with other Windows style programs click on a column heading to sort in ascending order Click a second time to change the sort to descending order The VIEW option allows you to select to see pending or completed studies The COLUMNS option allows you to select the columns to be displayed for the two different types of studies The displayable columns are Patient ID Patient Name Institution Name Time Modality Stat Marked as emergency Keep in mind that the DICOM standard does not tell how many images are in a series Therefore if a new study is being sent to your workstation give it time to arrive If you are reading a study and receiving the warning that more images are arriving it is best to move on to another patient and allow time for your network to deliver all the images before returning to that patient ic Note If your local archive is nearly full the following warning message will appear on the worklist screen Disk Drive Almost Full P
68. request from query RECORD _ Starts recording dictated remarks REMARKS _ Activates the dictation window for abnormal diagnosis REWIND To move backwards in dictation position RESET Returns image on active monitor to its original DICOM settings ROTATE Moves image 90 in a clockwise direction RUN Begins functions SELECT MODE Changes selection function on the Worklist SHUT DOWN Close system and go to Windows 2000 desktop VERIFY To call up the verification program for reports STACK _ Activates rapid stack or cine display algorithm STOP Halts functions UP QUERY LEVEL Moves query up one hierarchical level WINDOW LEVEL Activates the Window Level algorithm WORKLIST Displays the current doctor s worklist ZOOM Enlarges or reduces image on active monitor 3D Invokes the third party integrated 3D imaging package Form 330 4 001 Rev 05 Page 43 American Medical Sales Inc CaCCcL_L_a Diagnostic Workstation User Manual CHAPTER 16 WARNING MESSAGES Here is a list of the warning messages used by the COUCLLO Workstation A brief description is included in this table Warning Message Comment Printer Unavailable Print Job Aborted Draw a line and set line length or CANCEL to exit Invalid Password Network failure cannot connect to Scribe Be sure the Scribe Server pc is on and logged in Server _ properly Form 330 4 001 Rev 05 Page 44 American Medical Sales Inc CacCcL_
69. rst Patient Second Study Third 2 Series Fourth Image Conducting an Advanced Query Queries are conducted by layer therefore this process involves multiple steps Step 1 Click on QUERY on the Worklist Window Step 2 The Query Window will appear See Figure 21 The name and ID of the current patient will appear in the Query Info Name box Step 3 If you wish to query for a different patient click on the CLEAR PATIENT INFORMATION button Form 330 4 001 Rev 05 Page 28 American Medical Sales Inc CaCc_L_a Diagnostic Workstation User Manual Step 4 If you have cleared the patient information type in a name or ID number Due to the limitations of most database systems not COUCLLQ queries will respond with close matches only Therefore it is preferable to use ID numbers Step 5 Start your query by clicking on the QUERY PATIENT LEVEL button A filled in Query Window such as that found in the figure below will appear If no information is available a warning message will appear in the Status area at the bottom right of this window While CQUCLLO waits for a response the status of your Query will appear at the lower right side of the window Query Ina Ik a Name Study Serie Clear Pationt Information Patient Name Patient 1 Sates Query Complete i hous H mo SS pooien mt Figure 23 Query Window returned with Patient Level Information Step 6 If the Query returns items you can
70. s Stack Viewing All images on this version of COUCLLO are presented in the stack mode Stacked images are displayed in a similar fashion as seen in Figure 27 The following tools are available for stack viewing Zoom Enlarges the image Note that the percentage factor is listed next to the Zoom command see figure below Run Begins automatic stack viewing The length of time an image is displayed is controlled by slider bar below Stop Halts the automated stack viewing The RUN button changes to the STOP button once the run command is given Loop Plays the images in a continuous loop from beginning to end Sync You can move multiple series displayed on the same monitor together at one time To do this engage the Sync function on the monitor Window Level Source The workstation displays the stack using the window and level values found in the DICOM file These may differ for each image You may use the Window Level functions to adjust this display as you would for any other type of image See Chapter 4 See Figure26 for an example of the control section of the Activity Menu In addition the current frame number and the total number of frames is displayed Form 330 4 001 Rev 05 Page 34 American Medical Sales Inc CaCCcL_L_a Diagnostic Workstation User Manual CHAPTER 10 MPR Multi Planar Reconstruction Multiplanar Reconstruction MPR is a post processing technique that reconstructs the axial images
71. s have been entered for this imaging modality they will appear in the preference table To change images to a set of specific preset values go to the preference table and click on the desired description If there are more options than can be displayed in the table a scroll bar will display By clicking Use File Values label you can instruct the system to use the DICOM file values as sent to COUCLLO from the modality Contrast Equalize This adjusts the contrast of an image so that each intensity range has approximately the same number of pixels in it This algorithm may assist the health professional in visualizing subtle differences in the anatomy Activate by pressing the CONTRAST EQUALIZE button Optimize This process helps to assure that there is no pixel saturation in any area of the image The minimum value and maximum value of the window is determined and the image is displayed with the level set to the middle of this range Activate by pressing the OPTIMIZE button ic The image is set to these new window and or level values as soon as the option is selected and the same settings will apply to all images in the same series Reset This returns the image to the window and level settings specified in the DICOM header file Invert The Invert function reverses the black white scale for the selected image Form 330 4 001 Rev 05 Page 14 American Medical Sales Inc CaCcLL_a Diagnostic Workstation User Manual CHAPTER 5
72. s in a series are presented by the first image in each series The series currently being displayed in the Main Image Area is highlighted in outline in the Thumbnail Column To display a different series simply click on a different thumbnail in the column If more series are available than can be displayed in this vertical area controls are provided to move up and down the column Image Details COUCCLLG allows you display the DICOM header information For readers familiar with the individual entries in these records a vast amount of detailed information about how the image was captured and in some cases patient information can be found The figure below shows one page of the image detail file FIllHTiliiiiiifiiis i VE 4 Ub aah fei i Pri RETE ADET i bi i E eiri ORETTE Figure 16 Example of Display of Image Details on a Monitor Form 330 4 001 Rev 05 Page 19 American Medical Sales Inc CaCCcL_L_a Diagnostic Workstation User Manual Method i Show Image Details Activity Menu 1 Click on IMAGE DETAILS 2 Use the scroll bar on the display or the Page Up and Page Down keys on the keyboard to display additional sections of these details 3 Click on OK to close Image Details Window Print Image You may print the images being reviewed on any monitor by selecting the Print Image button from the Activity Menu When this button is selected a submenu will appear as per the example below
73. s product Figures used in this manual are representative only and may vary from what appears on the screen Attempts have been made to include all user functions but there may be variations with your installed version See your system administrator for updates Although CaQUCLLO products where applicable adhere to the DICOM 3 0 standard and are designed to be compatible with a wide range of other devices that also adhere to this standard device specific variations may occasionally occur which require intervention or adjustment Should incompatibility appear to an issue please contact your system s administrator so that they can contact the responsible vendors to discuss the related issues ic Power outages power surges storms temperature and humidity may affect computer equipment network equipment and communication devices and networks to which software is associated It is the responsibility of the user to protect the equipment and provide the environment to handle these possible issues If you are a third party installer not the end user you are required by the United States of America Food and Drug Administration FDA to maintain records relating to the installation and testing of this equipment These records must be maintained by you for FDA review It is recommended that these records be kept for the life of the product plus ten 10 years If the installer is unable to maintain these records at its place of business the records s
74. s supplied with the workstation and databases available from the user s facility The intended purpose of this device is to allow health care professionals to view the electronically available images and other patient information for review evaluation and possible treatment planning The Catella Diagnostic Workstation Version 4 0 is a medical image and information management system that allows easy viewing selection processing printing telecommunications and media interchange of multi modality medical images from a variety of diagnostic imaging systems The CacCCLLG PACS interfaces to various storage and printing devices using DICOM or similar interface standards The system is available for diagnostic and non diagnostic workstations including workstations designed as web based remote viewers or CD viewer workstations The software may be installed as a PC based stand alone system a software application a web based or SDK format and is designed to be integrated with various DICOM compliant OEM systems The cartella PACS displays stores prints and telecommunicates images from a number of medical modalities including but not limited to MR CT DR CR X ray Angiography Ultrasound or digitizers The CQUCLLO Diagnostic Workstation Version 4 0 performs other user defined post processing functions such as multi planar reformatting of images The CQUCLLO PACS can display processed data from certain FDA cleared third party image process
75. the on call feature is intended primarily as a wet read option Take care to purge older images that have already been interpreted by another physician ic IMPORTANT NOTE If another doctor logs in as the on call doctor the first doctor will be logged out A message will display to alert the first doctor that the status has changed This is done because 1 most physicians follow rotating schedules that will not overlap and 2 as an image management safeguard in case the first doctor forgets to log out when his her rotation has ended In the event that this transition takes place while images are flowing some of the patient s images will be on the first doctor s system and some will be on the second doctor s system In this case the technician may have to resend the image set to the new on call doctor or the doctor may query the Archive for the images is IMPORTANT NOTE Logging out cancels that doctor s on call status WHEN A PHYSICIAN S ON CALL ROTATION ENDS THE DOCTOR SHOULD 1 MAKE SURE THAT ALL IMAGES FOR THE LAST PATIENT VIEWED HAVE ALL BEEN RECEIVED BEFORE LOGGING OUT OF THE SYSTEM AND 2 THEN LOG OUT SO THAT NO FURTHER IMAGES WILL BE SENT TO HIM HER Once images are delivered to an on call doctor they will be erased from the Web Server As stated above these images will still be in their other destinations 1 e diagnostic workstations or archive for later use Form 330 4 001 Rev 05 Page 11 American Medical
76. those seen on your screen COCCLLO systems generally use portrait monitors If your system has been configured using a landscape monitor the displays on your system will vary slightly from those printed in this manual Regardless of your display configuration you should be able to follow the instructions in this manual Special Helpful Hints for Reading this Manual This manual has several conventions to highlight important information A indicates an important message Pay careful attention to these notes Please note the following conventions e Commands issued through the Activity Menu will be written in CAPITAL LETTERS For example CLICK on ROTATE e The use of the word Trackball is interchangeable with the word Mouse Form 330 4 001 Rev 05 Page 3 American Medical Sales Inc cartela Diagnostic Workstation User Manual CHAPTER 2 COLELLO WORKSTATION COMPONENTS COUCLLG Workstations operate on standard Windows 2000 operating systems Each workstation includes a high performance computer communications capability monitor s typically medical grade high resolution and video cards trackball microphone keyboard and foot pedal Each workstation s communication package is configured during the installation process to meet the requirements of the specific institution The appropriate COUCLLO software components are preinstalled on the system along with other necessary software The installation package in
77. tor To select a new scout simply click on one of the images Aam j ipm m f xi Epo lt Figure 19 Locator Selection Method Locator Select Activity Menu L Click on Locator Select on the Activity Menu 2 Review possible new scout images from those displayed 3 Click on desired image 4 Close locator window by clicking CLOSE Move Resize This function allows menus or image windows to be moved around on the screen and resized By clicking the MOVE RESIZE button a sub menu will appear in the lower right corner of the Activity Menu This menu allows you to move and resize the various elements of the monitor screen K Next Work List MP Imag E is E etails nsttuton Wakebjed Patent Location Senes Desc ROUTINE TIRM1 1_FLAIR_COR Move Resize Controls Single size The figure below identifies the elements that can be moved and resized Form 330 4 001 Rev 05 Page 22 American Medical Sales Inc CaCcL_L_a Diagnostic Workstation User Manual Main Viewing Area a Single or Quad Viewing Thumbnail Column ing Window Level and Tool Activity Menus i Patient Information Advanced Options on the Activitv Menn To move any element click on MOVE click on the element and drag it to a new location Similarly to resize any element simply click on RESIZE click on the element and drag it left right up or down Below see two examples On the left is a resized Main Viewing Area the to
78. ts to end users on condition that the end user may not grant sublicenses leases or other rights in the Software Products to others You may permanently transfer all of your rights under this License only as part of a sale or transfer of the Digital Workstation provided you retain no copies you transfer all of the Software Product including all component parts the media and printed materials any upgrades a copy of this agreement and the recipient agrees to the terms of this agreement If the Software Product is an upgrade any transfer must include all prior versions of the Software Product Without prejudice to any other rights American Medical Sales Inc may terminate this License if you fail to comply with the terms and conditions of this agreement In such event you must destroy all copies of the Software Product and all of its component parts All title and copyrights in and to the Software Product including but not limited to any images photographs animations video audio music text incorporated in the Software Product the accompanying printed materials and any copies of the Software Product are owned by American Medical Sales Inc or its suppliers The Software Product is protected by copyright laws and international treaty provisions You may not copy the printed materials accompanying the Software Product Limited Warranty American Medical Sales Inc warrants that a the Software Product will perform substantially in
79. ual size 7 Destination Add to Report Save Load PS PS ean _sove Delete Close Figure 14 Annotate submenu You may annotate an image with an ARROW a CIRCLE or with TEXT overlay The process is similar to that used in any common drawing program Select the mode you wish to enter by pressing one of the three Annotation buttons Move the cursor to the area of the image you wish to highlight M Save as Dicom C Smallest Image Change File Name When using the ARROW press the left mouse button and while holding the button down move the mouse towards the area of interest Release the mouse button where you wish to place the arrow s point When using the CIRCLE press the left mouse button and while holding the button down move the mouse towards the area of interest Release the mouse button when the circle has enlarged to cover the area of interest When using the TEXT press the left mouse button at the location you wish to begin the text comment to draw a text box Begin to type and press the lt Enter gt key if you wish to start a new line To delete any typing select it and press the delete key Once you have completed your annotation you can edit it by pressing the Edit button If the Save button is pressed the screen is saved If your network is using the Catella Scribe transcription software the image automatically will be added to the report You can also modify the resolution and the compress
80. word is entered COUCLLO automatically and without notice to the user logs out the old user You can now reenter under the new user name ic Setup Hint Set up a Standard Doctor Profile While logged into the Standard Doctor add new doctors This will give each doctor the same institution wide settings The Administrator can also reset the Worklist and the Error Log Identification Administrative DICOM Transier Alout catella Identification Tools Mane OGBE Od 0 Paseword New Password Conim New Password Figure 30 Identification Tab This tab allows you to change the entry password for the current user To change a password enter the old password and then the new password Form 330 4 001 Rev 05 Page 37 American Medical Sales Inc CaCCcL_LL_a Diagnostic Workstation User Manual Tools Identification OK Shutdown Log Oui Figure 31 Tools Tab Using these options each user can customize the way they use COUCLL Default Tool Each user can select the default tool that comes up when they begin each patient Pan is not an option because images never initially appear larger than can be seen on one monitor Multi Frame Images Choose the default setting to display or not display text overlay Orientation Markers Choose to display or not to display orientation markers Window Level Preferences Admimistraiive DICOM Transfer About catella pe Window Level Identificatio

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