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Visage 7 Client User Manual

1. 131 Display settings Visage 7 Client configuration Reset All Warnings Render Settings UI Appearance 132 If you had selected Do not show again for any warning that appeared since you called up Visage 7 Client selecting View gt Reset All Warnings will make sure that a warnings are shown again from now on This dialog box allows you to define render settings for the server and the local ren dering subsystem Check the Auto checkbox for Local Rendering and Rendering Subsystem to have the system identify and select the option best suited for your system configura tion amp Render Settings volume Rendering Artifact reduction none Image quality during interaction fastest best Use highres only where applicable Use low pass filtering Local Rendering Auto Rendering Subsystem Auto Only use Local Rendering set to ON and Rendering Subsystem set to Open GL manually if you are certain that this mode is supported properly by the graph ics card in your client computer Validate correct image display by loading and displaying test images View gt UI Appearance opens a submenu which allows you to choose between dif ferent color schemes for the user interface bright medium and dark This allows you to adapt the user interface to the ambient light conditions of your workplace Visage 7 Client Visage 7 Client configuration Protocol configuration Streaming Compression Selecting V
2. Select Edit Viewer Linking in this submenu to enter viewer group editing more In this mode icons that represent groups of image manipulation tools are shown in the various viewer segments You add a segment to a group by selecting the corresponding tool icon in a viewer segment End this more by confirming your selection checkmark icon in the lower right hand corner of the last viewer segment in which you have clicked a tool group icon 45 Viewer segments View Window MPR viewer segment An MPR viewer displays slice images e Original scan images belonging to a 3D volume created by a postprocessing ap plication single MPR viewers only but not for viewers of an MPR crosshair group Or e Reconstructed arbitrary slices through a volume dataset Immediately after loading a dataset and depending on the currently active proto col the MPR viewer segments show slices of the standard anatomical views In the MPR viewer segments you can perform various image manipulation and eval uation procedures such as changing image display parameters and using mea surement and annotation functions Use the viewer controls the mouse the MPR viewer context menu or toolbar icons to do so Tip MPR viewers showing the same image series are implicitly linked When you change display parameters in one MPR viewer segment all MPR viewers showing images from the same series will be updated as well When you have loaded a volume dataset yo
3. Similar to VRT however an additional virtual light source and a diffuse lighting model is used to add shades to the visual surfaces of the volume For example curved surfaces become darker towards the edges which results in a more nat ural appearance VRT specular An addition to diffuse shading specular shading uses a lighting model that re flects light dependent on the angle between the incoming and reflected light Visage 7 Client View Window Viewer segments This means that on smooth surfaces the user will see highlights and that the shading becomes even more expressive than with diffuse shading Specular shading is especially good for large surfaces with fine detail Projection modes in the 3D viewer Choose one of these projection modes for the 3D image from the viewer controls e Orthographic Orthographic viewing is like viewing an object through a lens with a very long fo cal distance telelens where the viewing rays are almost parallel to each other and no perspective distortion occurs e Perspective This display mode gives a more natural impression It corresponds with the ev eryday experience of perspective distortion Objects that are far away appear smaller than objects close by Tip In orthographic mode you can perform 2D measurements in the image plane e g distance and angle measurements In perspective mode this is not possible 3D viewer context menu The 3D viewer context menu provide
4. The following Options are additionally available e You can change Series Number and Series Description for DICOM files e You can select Burn in Patient Information and or Burn in Orientation Letters for im age files e You can select Burn in Patient Information and or Burn in Orientation Letters and additionally change the Frame Rate for movie files Click Export to start batching and the export A message is shown once it is finished Open Tool Card Opens the Batching tool card where you can select one of the three methods of batching and other options as described under Batching tool card Cancel Click this icon to cancel batching 108 Visage 7 Client View Window Additional tools for time series analysis Additional tools for time series analysis Visage 7 Client provides two additional functions specifically for time series analy S S Time density analysis for ROIs Basic workflow T Time density analysis allows the observation of the density progression in a ROI over time in time resolved 3D datasets The density progression is shown in a plot which displays the density graphs of one or several ROIs 1 Load a time series 2 Show an image from the baseline phase in an MPR viewer 3 Draw a ROI See Annotation and Measurement tools 4 Select Time Density Analysis in the context menu In order to add the time analysis graph of a second ROI to an existing time analysis plot 5 Draw a second
5. Visage 7 Client configuration Display settings Display settings Drop down the View menu of the Study Browser or View window for a number of configuration options that affect View window or image display aspects Viewer Properties Viewer Properties Reset All Warnings Render Settings UI Appearance Streaming Compression This dialog box shows allows you to define display settings for the View window us er interface The Viewer Properties dialog box also indicates whether a setting is a factory default or a system or user level configuration setting With appropriate user privileges you can change the assignment of configuration settings to user or sys tem level here Visage 7 Client W Properties Property Modified Defined in User Interface Text Overlays in Viewer Text and Line Color a 255 255 255 255 factory default Red 255 Green 255 Blue 255 Alpha 255 Font Size for Large Monitors 12 ETAU factory default factory default factory default Font Size for Midsize Monitors 10 Font Size for Small Monitors 8 Text and Line Shadow Color 0 0 0 255 Red 0 Green 0 Blue 0 Alpha expand all collapse all Please note that properties highlighted in will be overridden by this protocol even when they are saved in the user profile Reset user profile Tip The Viewer Properties dialog box shows a subset of the user interface configuration options of Properties dialog for a better overview
6. c cccceccccccecccecececucccececaucesececetecseecuuacauauauaeausenensnens 123 Information in the Performed Procedures list 2 0 00 cc ceecececeececeecececeeeececeeeeeeeeeess 123 Menu and Icons of the Performed Procedures liSt c cc cece eceececececececececeees 124 Scheduled Procedures liSt c cccccecececscececsceccccccucececececscecacscauauauauausecenenenseas 126 Information in the Scheduled Procedures liSt cece eececcececeececeeeeeececeseeaeeeeess 126 Menu of the Scheduled Procedures liSt cccccccececcececececcececeecececeeeeceeeeaeeeees 126 Visage 7 Client configuration 127 General MreEteren COs usean en tease iseaccceiaaace eens e aa 127 MOOR GORTIG UT AMON ececeierce tetas ssccctadt ea a RE 128 Window Level Presets caicienceviacsedeaacele ie eed aan ee HORA Als 128 KE VOO AIG SHOMCUTS seeiis n aN E RE E S EaR 129 WSO CU Ce sett vi ok etre r a acetal eateries dines Dune aste 129 FOG 6 aii taitte narra crak A uate 130 DIS DIA SeN S ia e a r R a iamunbarteiomuiuans 131 Viewer Properties ccccseecccseecccceeeecesseeceeseeecesceceeeessageecseaeesseceeessegsesseeeessass 131 Reser PAIL VV IMUING S seriat a rae Sala ales 132 Render Sening osnon iea cctenat nano saledinetaslentoueete nea 132 Il POD CAVING C nona a a a 132 Streaming GCOMPLESSION eicssc cick tos hvac Sebi he a caved 133 Visage 7 Client Table of Contents Protocol configuration cccccceeeeeeeceeeeeeeeaeeeeeeeeaeeeeee
7. Double click the Visage 7 Client icon in your Applications via the Finder All users 1 Enter the name of the server in the Server Name field or choose one from the list 2 Enter your User Name and Password 3 Select the user interface Language 4 Activate or deactivate Integrated Windows Authentication for future program Starts not applicable for Mac users Visage 7 Client 19 Changing your password starting and Ending the Program Note Integrated Windows Authentication is only possible for users whose accounts were imported in the Visage system from Windows and for whom the integrated Windows authentication privilege has been set by the system administrator 5 Click Login to start the program The Visage 7 Client application program opens and the Study Browser is shown in the foreground You can now define and start a query for case data in your database browse through a history of recent queries and start one of those queries or load a re cent session from the session management box Changing your password You should change your password from time to time for data security reasons 1 2 3 Open the Visage 7 Client Select File gt Preferences gt Change Password from the main menu Enter your Old Password the New Password and repeat the new password in the Retype New box Press RETURN Use the new password from now on when logging in Exiting Visage 7 Client Logging off from the
8. 10 pixels 12 20 pixels 6 50 pixels 2 5 100 pixels 1 1 Larger errors can occur if the image is displayed with reduced matrix size that is if not every original pixel is shown on the window due to zoom out For optimum ac Curacy we recommend zooming into the structure of interest as much as possible The accuracy is further limited by the physical resolution of the acquisition itself If the monitor used for display does not permit exact pixel selection the inaccuracy can be greater still Distance Ratio gt lt Click this icon and perform distance measurements The system will display the length of the two distance lines and the ratio between the two measurements Vertical Distance Click this icon and two points in the image Visage 7 Client will draw two horizontal lines and measure the vertical distance between these lines 62 Visage 7 Client View Window Visage 7 Client Toolbars Calibrate Image only in 2D images Some image types have no aspect ratio information in their DICOM image header For these images distances cannot automatically be expressed in millimeters You can howev er calibrate the distance tool using known distances in images e g image markers or the length of a ruler Click this icon and measure a known distance Enter that distance in millimeters in the Calibrate dialog box Elliptic ROI Click this icon and draw an elliptical ROI The ROI area is indica
9. 45 49 Fusion display 79 aligning datasets 68 overlay dataset 80 primary dataset 80 Fusion Registration tools 68 H Head icon 59 Horizontal Rotational Batching 105 Image preview Study Browser 36 Image Series tool card 52 Image text 40 show hide 40 Images browsing 59 calibrating distances 63 flipping 60 measuring 2D ROls 63 measuring angles 62 measuring Cobb s Angle 64 measuring distance ratio 62 measuring distances 61 measuring pixel density 64 measuring spherical ROIs 63 measuring vertical distances 62 orientation 59 panning 58 resizing 60 rotating 58 60 windowing 59 zooming 58 Insertion Date database filter 29 Installation 17 Intended use 7 IWA Integrated Windows Authentica tion 18 J JPEG images 85 K Keyboard shortcut 56 L Layout 2D viewer 51 Left icon 59 Leg Bones removing 68 Lesion tools 73 Lesion tool icon 73 Licenses 8 Line Profile tool card 88 Link Current Position icon 69 Link Display Properties across Viewers icon 69 Linked viewers 39 Linking automatically 69 edit 69 toggle navigation 69 viewer navigation 69 windowing 69 Load Session 110 Loading bone segmentation 92 session 110 Loading data 27 34 Lock Crop Region icon 66 Login 18 Login dialog box 19 Logoff 20 Lumen view 71 92 Lumen View icon 71 Lumen viewer display set
10. 59 Standardized Uptake Values SUV 89 Statistics tool card 98 Store Key View 45 49 Structures analyzing 96 defining 96 Structures tool card 96 Study Browser window 27 Study Date database filter 29 Study sessions 35 Study series list Study Browser 31 Subtract baseline icon 72 Subtraction time series 109 SUV based on body surface areas 89 based on body weight 89 based on lean body mass 89 SUV tool card 89 System requirements 9 7 Table removing 68 Templates tool card 78 Thick slices 47 48 Thin MPR 48 Time series analysis 109 Time density analysis 109 Index Toggle All 40 Toggle Centerline icon 70 71 Toggle Linking icon 69 Tool cards 76 floating window 76 resizing stack 76 resizing window 78 showing hiding 76 stack 76 Toolbars 56 show hide 57 Tools 76 U Upgrade 8 US ultrasound 29 User defined 3D templates 78 color maps 81 V Vertical Distance icon 62 Vertical Rotational Batching 106 Vessel tool card 90 Vessel segmentation 71 Vessels analysis 92 cross section view 92 curved view 92 lumen view 71 92 show hide centerline 45 50 shutter 92 tracing 91 View button 34 View DICOM Parameters 110 View Orientation 45 50 View Study Reports 45 49 View window menu 110 Viewer Control 45 49 Viewer controls 41 Viewer linking 39 69 Viewer li
11. and Increment Select a rotation axis and decide whether this axis refers to the patient coordinate system or to window coordinates Check this box for slow playback or recording in best 3D quality Only active for time series With this checkbox you decide whether you want to apply cine mode to all viewers or wheth er you want to play the film in the selected viewer only Click Play or use the keyboard shortcut C to play your film back once Click Pause or use the keyboard shortcut C to halt the playback 87 Tool cards 88 linear log x y axis E E View Window Select Loop to play the film in an endless loop Click the Record icon to open the Cine Options dialog box Here you can choose whether you want to save your film as an MPEG movie on your local computer or as separate snapshot images like in a slide show or as a new DICOM series on your local computer or on a connected DICOM server Line Profile tool card The Line Profile tool card shows the grayscale or HU value profile of the currently selected distance line in the image currently shown in the active viewer If there is only one line in the image that line is shown automatically If you have moved a distance line that was in your way no line profile can be shown Move the distance line back to its original position to redisplay the line profile Line Profile fou mj Linear b oc Select linear or logarithmic scale
12. like this e Images can be moved to series studies or patients If they are moved to a patient a new study and series are created if they are moved to a study a new series is created e Series can be moved to studies or patients If they are moved to a patient a new study is created e Studies can only be moved to patients After selecting two items and clicking on Move a safety query is displayed so that you can check your selection before confirming it Splits the selected study studies or series and creates a new data record to receive your se lection You will be prompted to enter data on patient or study level for the new data record Move one or more selected series to a new patient You will be prompted to enter patient in formation for the new patient that will automatically be created to receive the selected se ries Click Force Update if you want to update the DICOM files even if no changes to the database are made Merges two selected patient data records into one You will be prompted to select the target data record to which the other one should be assigned which is deleted after merging Visage 7 Client Quality Assurance Performed Procedures list Edit Lets you change a data record on patient study or series level depending on your selec tion Click Force Update if you want to update the DICOM files even if no changes to the Q database are made Delete Deletes one or more selected images series studies
13. 1 Table of Contents Study Browser 27 Query Sechna saa E e a N 28 Filer MG search entenas O ae a a ral 29 Starting and resetting a searGhi corsare a aa a aa E 30 QUS DIESEIS ia a Sieakabidntadeactaduabnandeteiinchiuethes 30 Context menu of the preset DUTtONS cc eccceeeceeeceeeeeeeeeeeeeeeeeeeeeeaeeeeeesaeeeeeens 31 Study Series MIS Us xsccccoshsasstetcen ste Seen idsaanedeeddnndvaenaddcdeasttecdebeicosdibbeackasaoneeeueiautecbeeadees 31 Information in the StUdy Serie s list ccccccccsecceceeceeeeseeeceeeeeseceeseeeeeseeeeseeeeeas 31 Context menu of the Study Serie s liSt cccccseececeeceeeeeeeeeeeeeceeeeeseeeeeseneeesanees 32 Loading retrieving OF removing data cccccceeccceceeceeeeceeeeceeeeceeeeseeeeseeeeseessaaes 34 Session Manageme eeens a a a 34 Preview Image S cocaine Maartaainastat ucwhecaaatictaantan deen ininaaidtainandndaliyanee eda te 36 View Window 37 PrOtOCOl S cenena E E aE 38 Viewer segmen S roan aara a E nud ebaomaanbtiont 39 SD Viewer segmen aeara a a vad teat A 41 3D rendering techniques in the 3D viewer cccccccseceeeeeeeeseesceceeeeesaeeeeeanees 42 Projection modes in the 3D VIQWEL ccccccccsseeeeeceseeeeeeeeeceeseaseeeesaaaeeessaaeees 43 SD Viewer COMIEXT MENU isidi E a 43 MPR viewer SCQMENN cccccccesceccesececeeceeceaeecseeecsuueeesaueeesaeeessueeessaeeessaeeessags 46 NAVIGATION CrOSSNa senie a e eaelunau eae sie 47 Compositing modes for t
14. 3D structures the contours that define them in a tree view Structures and contours are numbered Use Rename Structure and Rename Contour from the context menu in the structures list to give your structures and contours descriptive names Vol Area Shows the calculated volume for 3D ROIs and the area for 2D ROIs Color box Visage 7 Client assigns each structure a color Double click the color box in the structures list to open the color selection dialog box Select a different color if required MPR Check or uncheck these boxes for a structure to show or hide its contours in the MPR view er segments 3D Check or uncheck these boxes for a structure to show or hide it in the 3D viewer segment Click the New 2D button to create a new 2D structure This requires drawing a contour in one slice image only As soon as you have clicked this button a context toolbar is shown in the lower right hand corner of the active viewer segment This toolbar offers two alternatives to start contour def inition definition of an elliptical contour or definition of a freehand contour Click in the image and draw your contour When you have finished the system switches into refine mode automatically When you now click in the image a nudge tool is shown This tool has the shape of a circle The further away you click from the contour the larger the cir cle will be The closer to the contour line you click the smaller it will be When you have
15. Image icon 60 O Online help 15 Orientation tools 59 Orthographic 3D projection 43 Overlay dataset 80 P Pan icon 58 Partial Crosshair 50 Password change password 20 Patient ID database filter 29 Patient name database filter 29 Perspective 3D projection 43 Pixel density 64 Pixel Value icon 64 PNG images 85 Point Sized ROI icon 63 Position Crosshair icon 59 Visage 7 Client Index Visage 7 Client Posterior icon 59 Previous Phase of Time Series icon 60 Previous Study icon 60 Previous Volume or Muliframe Image icon 60 Primary dataset 80 Protocol 38 111 dynamic protocols 39 PT positron emission tomography PET 29 Q QA 119 Database query 120 Date of Birth database filter 121 Fields database filter 122 Insertion Date database filter 121 Modality database search 121 Modification Date database filter 121 Patient ID database filter 121 Patient name database filter 121 Study Date database filter 121 Wildcard search 120 Quality Assurance 119 Query presets Study Browser 30 Querying a database 28 R Recall Key View 45 49 Registration 68 Remove tools 67 Remove Chest Wall icon 68 Remove Leg Bones icon 68 Remove Table icon 68 Report creating a report 113 LV analysis 101 Report editor toolbar 116 entering text 117 placeholders 117 templat
16. Orientation Letters for im age files e You can select Burn in Patient Information and or Burn in Orientation Letters and additionally change the Frame Rate for movie files Click Export to start batching and the export A message is shown once it is finished Vertical Rotational Batching Number of Images Increment Image Thickness Overlap and Direction buttons for GR Allows you to review change the parameters of vertical rotational batching The parameters forwards and backwards rotation are available Clicking on the lock symbol before either Number of Images Increment allows to change this parameter by means of dragging the mouse within the viewer Other parameters may be adapted automatically to keep the data consistent 106 Visage 7 Client View Window Properties Save Send Batching toolbar Visage 7 Client Export F 2c Batching tools Clicking this button opens the Properties dialog for horizontal rotational batching The Value column will show possible changes you have already performed on the tool card In the Modified column a checked box shows that a value was changed and in the De fined in column the value will be set from factory default to user profile You can click Save in user profile to save the changed parameters or reset to the factory defaults by clicking Reset user profile Initiates batching and a DICOM Send action A dialog is opened where several properties as in the P
17. ROI 6 Select Add to Time Density Analysis in the context menu Subtraction for time series Basic workflow Visage 7 Client Subtraction mode allows you to subtract the baseline phase from the other images of a time series The resulting image shows only those structures where changes occurred over time now e g the flow of contrast medium 1 Load a time series By default the first image in a time series is the baseline phase i e the image that will be subtracted from other images If you want to subtract another image 2 Use the Previous Next Phase icons on the Dataset Navigation tools to navigate to a different phase in the time series 109 View window main menu View Window 3 Select Select as Baseline Phase from the context menu to define this phase as the baseline phase 4 Click the Subtract zero phase icon View window main menu This section describes menus and commands that are available only if the View window is shown in the foreground Refer to Getting Started for a description of menu and commands available on all Visage 7 Client windows File Import DICOM Directory Import DICOM Files Save Protocol Reload Protocol New Session Load Session Save Session Save Session As Email Session Link DICOM Job List View DICOM Pa rameters Preferences Allows you to load a DICOM directory from hard disk CD or from an external drive Return to the Study Browser after DICOM Direc
18. Session As Allows you to select and redisplay one of the stored key views Allows you to delete a key view you created earlier during your session Shows or hides the navigation crosshair in MPR viewer segments 49 Viewer segments Partial Crosshair Bounding Box DICOM Overlays DICOM Shutters DICOM Annota tions Centerline DICOM Print View Orientation Properties Attach Detach Viewer Scoutlines 50 View Window Shows or hides a section in the middle of the navigation crosshair which might be in the way when reviewing images Note that when this option is selected you cannot move the entire crosshair the cursor will not change shape when you point to the crosshair intersection see also Navigation crosshair You can however move single crosshair lines Advanced users can toggle display of the partial crosshair via keyboard shortcut key X Shows or hides a box delineating the volume borders in the MPR viewer segments If a dataset contains DICOM overlays use this context command to show or hide them If a dataset contains DICOM shutter information use this context command to show or hide the shutter If a dataset contains DICOM annotations use this context command to show or hide them DICOM annotations are more comprehensive graphic and text annotations than DICOM overlays and they are stored in DICOM presentation states Turns on display of the centerline for vessel segmentation for this viewer
19. The x axis shows the length of the line s the y axis represents grayscale or HU values In fusion mode when a primary and an overlay image are active in the same viewer two profiles are shown one for each image The colors of the lines correspond to the colors of the units shown on the two X axes Click this icon to create a snapshot of your line profile s The snapshot will be added to any snapshots of image data on the Export window from where you can save it to hard disk Click this icon to save the data of your line profile onto your hard disk as a comma separat ed list csv file Visage 7 Client View Window Patient weight height sex Radionuclide data Reset to DICOM values Data Window Unit radio but Visage 7 Client tons Tool cards SUV tool card PET images contain data that represent radionuclide activity in the patient s body This data is usually indicated in units of Bq ml Visage 7 Client can convert these values in Standardized Uptake Values SUV based on the radionuclide activity and the patient s anatomy Visage 7 Client algorithms for the following SUV standards e SUV based on body weight e SUV based on lean body mass e SUV based on body surface areas On the SUV tool card you can select which value to use and check or correct the pa tient and study data required for SUV calculation Note The values displayed on the tool card refer to the volume dataset currently shown in t
20. Tip Before you start vessel tracing rotate the volume in the 3D viewer and remove any obstructing structures so that you have a particularly clear view of the vessel or vessels in question e Vessel analysis As a result of vessel tracing the system has identified your vessel in the dataset The vessel is highlighted in the 3D viewer segment surface shading You can now switch on lumen view which helps you to locate areas of interest along your vessel You can also show a cross section of your vessel in one of the MPR viewer segments and use a shutter for easy navigation Visage 7 Client View Window Vessel tracing Vessel Visage 7 Client ial Tool cards The vessel tools support the physician in finding vessel like structures in the im age data and in navigating quickly along these structures for efficient review However the software cannot guarantee that the detected and displayed struc tures correspond to an actual vessel fragment It is the responsibility of the user to check the plausibility and accuracy of the presented data vessels and Centerlines al aa Clear E ff Trace small Lumen i i Ei LUM Click the vessel you are going to define Double click the default text Vessel1 for example and overwrite it with the name of the vessel if you want Or Select Insert New Vessel from the context menu of the vessels list Click Edit to start curve definition A co
21. Tool cards View Window When tool cards are shown as floating windows they are usually displayed in a size that ensures they are not in your way while you are reviewing images You can en large these windows if you like Click the lower left or right hand corner of the window and drag it out to show the tool card larger Visage 7 Client tool cards User defined 3D templates 18 Tool cards offer controls for changing image display settings and supporting the us er with advanced image review and evaluation tasks Some of these functions apply to all viewers while others provide different tools depending on the currently active viewer type When the 2D viewer is your active viewer segment most of the evaluation options on the tool cards are not available as they apply to volume datasets only Tip If you cannot find one of the following tool cards in the drop down list of tool cards or in the main menu select a different protocol Templates tool card 3D viewer Templates offer a quick and easy way to optimize the 3D volume display in the 3D viewer segment for specific tasks A template defines volume rendering and display parameters for volume datasets of a particular modality or combination of modalities A template stores the following information e The modality of the primary and overlay dataset e A color map for the primary and overlay dataset see 3D Color Map tool card 3D viewer e Rendering and display
22. View Delete Key View Crosshair Visage 7 Client Viewer segments Fullacreen af Viewer Control View Study Reports Primary Study 2006 Jan 28 7 CT SNCT132CTS BRAIN Voy Image set 3D Volumes 1 Overlay Study none store Key wiew Crosshair Partial Crosshair j Bounding Box DICOM Overlays DCOM Shutters Centerline View Orientation Properties Attach Detach Wiewer ue Link Viewer Navigation ve Reset Viewer Linking Scoutlines Select this menu option or double click in the MPR viewer segment to display the MPR viewer in full screen mode Select the command or double click again to return to the previous screen layout Check or uncheck this commands to show or hide the viewer controls bar below MPR view er segments If a study report has been sent to the Visage from the RIS you can show this report in a separate window with this command Only for time series Defines the current phase image as baseline phase In a time series analysis this defines which image will be subtracted from all the other images in the time series Stores what is currently shown in the currently active highlighted segment as a key view During your session you can return to this view using the Recall Key View menu entry or by pressing F11 F12 Previous Next Key View Note that key views are lost when you close Visage 7 Client or load new data To preserve key views save your session File gt Save Session or File gt Save
23. archive option e The availability of the cardiac analysis option for Visage 7 Client e The availability of the oncology option for Visage 7 Client e The availability of the neuro option for Visage 7 Client Visage uses the so called floating licenses concept This means that a license is not bound to a particular user name or a dedicated workstation or computer A li cense for 10 users means that 10 users can work with Visage 7 Client simulta neously If an 11th user tries to log on he or she is told to try again later Once one of the original 10 users logs off logon of the 11th user will be permitted Of course licenses can be upgraded When upgrading an installation the old license becomes invalid The new Visage li cense which comes with the upgrade must be installed If a larger data volume was licensed in a previous version this may lead to the old est data being deleted from the system after the new license has been installed de pending on the auto delete settings defined by the system administrator Visage 7 Client System Overview system requirements System requirements When describing system requirements we make a distinction between server and clients Server Visage runs on standard server platforms Server hardware must be qualified by Visage Imaging For a detailed server hardware and software specification please contact your sales representative Clients These are the minimum hardware and so
24. cameos E E REEERE 9 Data protection and data SECULILY ccccccccsssescecceeeceeeseeeeeessaeeeeeeeseeeeesaaeeeesesaanes 10 Access control and authentication nnn0eannneenneeannnnennnnnrnnnenrnnrenrrrrrnnrrrnennrenne 10 AUGAS e E E E E E a dose vagtsee iat 11 Overview of the product COCUMENTALION ccccceeeeceeseeeeeeceeeeeeeeaeeseeeeeeeeeessaeeeenens 12 User and administrator COCUMENTALION ccccceeeececceeeceeeeeeeeeeesaeeeeeeeeeeeseaaaeeess 13 Information on using the Visage MANUAIS cccseccesseeeeeeeeeeteeeeesseeeeseeeeeesaeeees 14 Information on using the online help SYStEMS cccceecceeeneeeeeeeeeeeeeseeeeeeesaeeees 15 Starting and Ending the Program 17 Installing the Visage 7 Client ccccccceccccsseeecseeeeceeseecseeeecsaueesseeessageessseseessaeeens 17 Staring Visage 7 Ollessaan ee es tual eat ee a 18 Starting Visage 7 Client from the login dialog DOX ccccccceeeeeeeseeeeeseeeeeeesaeeeeeens 19 CHANGING OUI DAS SW ON Classe ac eh aah da eo aia a eae 20 Exiting Visade 7 GIGI suicsteios duvinccradeli ccc luidussdu a A a 20 Getting Started 23 The Visage 7 Client WOrkflOW cccccccsececseseeeceeeceeececseusesseseeeseueesnaseeessueeessaeeess 23 The general Visage 7 Client window layout eccccceeeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeens 24 Visage 7 CIENT WINGOW Sic sisted viel icec uiaetbiadamn a ance dated edad 25 Menu DAT ohicttcsiecs tere igea e E E 26
25. collapse this list For a better overview you can sort the list by clicking on a column header Clicking a second time reverses the search order Hovering with the mouse above a list entry without clicking shows information about this study in a tooltip For example hovering above the first column shows the as signed labels Name of the patient Patient s identification number Job number of the patient in the HIS RIS hospital or radiology information system Modality or modalities used to examine the patient 31 Study series list Images 3D Study Series De scription Study Series Date Insertion Date Study Browser Number of images in a series on study level no image number is shown Shows a graphical icon when a series is a 3D series i e contains at least one continuous 3D volume A green bullet indicates that a 3D volume dataset is available on the Visage server lo cal database i A yellow bullet indicates that the system is currently creating a 3D volume dataset from the original slice images Study or series description Date and time when the study or series was performed in the format YYYY MMM DD and HH MM SS 24 hour clock Date and time when the study or series was sent to the local database in the format YYYY MMM DD and HH MM SS 24 hour clock Context menu of the study series list View Add to View View All Series Side By Side View All Phases Side By Side Fin
26. curves individually Note that when you create a report only those curves that are currently shown will be includ ed This segment or tool card view shows the accumulated wall motion in the bull s eye view Move the cursor across this display to see region names as tool tips or right click and toggle value and segment ID display In order to calculate myocardial mass proceed as follows 1 Open the Edit tool card 2 Lock the object Left Ventricle 3 Show a suitable phase image in one of the MPR viewers 4 Select the Define Contour in 3D tool on the Edit tool card 5 Draw acontour around the heart in the MPR viewer prefereably in the short axis view Adjust the contour if necessary 6 Scroll up or down a few images and repeat the last step for several images 7 Add your selection to the object Myocardium by clicking the plus sign next to the object label on the Edit tool card 8 Return to the LV Analysis tool card Visage 7 Client View Window Basic workflow Calcium Scoring Multi Slice Mode Visage 7 Client Tool cards 9 Click the Calculate Perfusion button again The system recalculates the LV analysis and adds the myocardial mass to the LV Results Calcium tool card Visage 7 Client provides a tool card for identifying the extent of calcified plaque in coronary arteries for CT series In order to perform calcium scoring you proceed as follows 1 Select an MPR viewer that shows an
27. data input and selection options You should also have experience with overall keyboard and mouse operation The Visage 7 Client workflow Study Browser Visage 7 Client The basic workflow with Visage 7 Client is very straightforward and indicated by the arrangement of windows on the user interface You open these windows by select ing the respective entries in the Window menu or by clicking the following buttons in the upper right hand section of the application window Windows only Study Browser In the Study Browser you query the Visage database or connected network nodes for patient and study data Once you have found the data you are looking for you load this data onto the View window The View window Is shown as soon as you have loaded data If your Visage is integrated in another clinical software application you may skip this step and window In this case you select the data you wish to review in that program and then advance directly to the View window View On the View window you review and analyze 3D volume datasets You can ma nipulate image display and create new slice images from any position and in any orientation in the process Moreover you can evaluate areas of particular inter est and perform various measurements and calculations In order to document your findings you create snapshots of relevant images 23 The general Visage 7 Client window layout Getting Started e Export Export You u
28. documentation addresses clinical users lt comprises The Visage Web Client user documentation In these documents clinical users will find a complete description of the Visage Web Client user interface and program functionality In the printed user manual you will find a complete description of all Visage Web Client functions The online guide offers additional information and task oriented descriptions presented in a step by step style Online guides are available in English and German Visage Web Client also features a context sensitive online help system which you can call up right from the user interface The context sensitive help topics explain all the user interface elements and features of the currently displayed window in your native language For the English and German user interface the online help system also contains task oriented step by step instructions The Visage 7 Client user documentation The user manual this document provides a complete description of all Visage 7 Client functions Visage 7 Client also features an online help system which you can call up from the Help menu The various help topics explain the user interface of the client software The Visage administrator documentation supports system administrators in a hospi tal It helps them with user management and adapting the system to changes in the overall network environment if this becomes necessary The Visage administrator documentation als
29. lines in any of the image segments and drag them in or out or you can rotate the crop region by dragging a corner When you have clicked a crop tool the Lock Crop Region icon appears in the lower right hand corner of the active viewer segment The icons may look slightly differ ent from this icon here depending on which crop tool is currently active Clicking this icon locks the crop region and allows you to move or rotate within the crop box or slab Tip Show the bounding box in the 3D viewer segment before you select a cropping tool see 3D viewer context menu options This will help you to identify the por tions of the volume to be cut away Crop Box Select this tool to cut away the outer parts of the volume A smaller volume box in the center of the volume dataset remains You can move resize or rotate this box by dragging or rotat ing it in any of the viewer segments Crop Corner Select this tool to cut away a box from the corner of the volume Visage 7 Client View Window Visage 7 Client Toolbars Crop Slab Select this tool to cut away portions of the volume so that only a slab remains i e a section of the volume between any two parallel planes with oblique orientation Use the Viewer controls or the keyboard shortcut T in the 3D viewer segment to change the slab thickness or to toggle slab display on and off Crop Plane Select this tool to cut away a corner of the volume along an oblique cutting
30. loading segmentation 92 performing segmentation 92 Bounding box 45 50 Brain Perfusion tools 71 Browse Slices icon 59 C Calcium tool card 103 Calculate Perfusion icon 72 Calibrate Image icon 63 Centerline 45 50 Chest wall removing 68 Cine tool card 85 Circle Annotation icon 61 Circular ROI icon 63 Clear Points icon 70 Client installation 17 Cobb s Angle icon 64 Color map delete tissue 83 editing 83 new tissue 83 user defined 81 137 138 Comma separated list 88 99 104 Compositing modes thick slices 48 Connected Voxels in Value Range 3D icon 95 Context menu 3D viewer 45 MPR viewer 49 CPR viewer display settings 81 CPR Vessel tools 70 CR computer radiography 29 Crop Box icon 66 Crop Corner icon 66 Crop Plane icon 67 Crop Slab icon 67 Cropping removing parts of the volume 67 Cropping tools 66 Cross Section view 92 Crosshair 45 47 49 moving 47 59 moving line 47 positioning 59 rotating 47 slice thickness 47 viewing direction 47 Cross Section View icon 71 CT computed tomography 29 Curved planar reconstruction CPR 70 Curved view 92 Curved View icon 70 71 D Data protection 10 Data security 10 Database 28 deleting data 34 loading data 34 Database query 28 Dataset alignment 68 Dataset Navigation tools 60 Date of Birth database filte
31. of 3D color 81 Tool cards 82 Primary Dataset Overlay Dataset Color map selection Color map editor View Window maps When saving a new or adapted color map back to the Visage server you can decide whether to make it available for all users or save it under your own user ac count only Note Some of the available color maps e g gray ramp and temperature can only be edited to a limited extent Only the data windows of the tissue types of these color maps can be adjusted but not the color and transparency settings Changes to these color maps cannot be saved either 3D Colormap Primary Dataset CT Bone Defaut fall oe eo ee ee Esmee O a N r 8 Fusion mode only Select which of the two color maps you want to edit the one that is used to display the pri mary dataset or the one that is assigned to the overlay dataset Click the arrow button next to the currently selected color map label to drop down a list of all color maps available in your system The color map editor shows the histogram grayscale or HU values of the selected dataset as a background image The graphs that overlay the grayscale histogram represent the tissue types and their dis play definition with respect to color and transparency for VRT rendering You can edit these graphs in order to change the color map You can change the data window for a tissue type You can select different colors for each graph You c
32. plane Remove tools These tools provide options for the automatic segmentation and removal of specific structures from 3D datasets They also offer a subtoolbar for segmentation and cropping of freely definable volume sections Freehand cropping can be performed in all datasets The automatic segmentation tools remove table remove leg bones remove chest wall support the physician by hiding structures that occlude important information in the images However the software cannot guarantee that the detected pixels correspond to the actual anatomical structures for each individual patient and scan It is the responsibility of the user to check whether any relevant structure has been accidentally removed In that case simply click the respective tool icon to bring the removed structures back Freehand Crop Click this icon to start freehand cropping A context toolbar appears in the lower right hand corner of the active viewer segment Proceed as follows 1 Select the viewer segment which shows the structure you want to crop particularly clear ly 2 Click and drag the mouse around the structure When you release the mouse button the system closes the shape 3 Select if you want to remove what lies inside your shape Remove Inside or what lies outside Remove Outside on the context toolbar The system now determines what to remove from the volume by extruding the drawn shape through all slices of the volume in the direction or
33. ranen a 71 M ltiphase TOOIS iz ostarncuitcodedaroveuntecunsnaciacansunuer aaa a aai a a a aia is 72 LESION TOOLS mirror o ae ne are era 73 WANDS S TOOS ci oss cca teva a sesasetiee bak octtie e Ees 74 MUISCEIIANCOUS1OOISicateitacctetelece e res eieimeteued tenses ieee ieete ei 74 TONG AROS hess iste cet ra a dete syudectouessieeeddaceule elu eset toe ton ia 76 SNOWING AOON CAN Geter oie toe cas tates eh its E 76 Tips ftorarranging tool CANS wrist isso sae a Lelie cme 76 Vsade 7 Clienti Cald Sacsan a 78 Templates tool card 3D viewer cccccceeeceeeseseeeeeeeeeeeseeseeeeseaeeeeseeeeessaaeeees 78 DiSplav tool Card sea AA E 79 3D Color Map tool card 3D viewer cccccceeccecceeeeeeeseeeeeeesseeeeesaeaeeeesaaeeeeesaees 81 CNE TOOL CaN O ana a A i 85 ENSPE TOO CaO siea E bead eienieh nce saats 88 IW TOON Ca ewes ate a Geet cuenta ato bentetntasnedutecaveleatntaskAun EG 89 Vessels and Centerlines tool Card cccccccsseccccessseeeeeeeececcaeeseeeseeeeeeesaeeeeesaaes 90 BONE 1OG kG al Gira anzdecuangedadsesadanentannstetactenc uence tarceedalel alae caseteanacandtedlamete antennae 92 FG TOO CANO cinta acta tana E sain tac edadecctebeaciddeteh A wader thadeasiect 94 Siruct res TOO ICON ez sete cite oh aie et ee atleast ed Sat ohatiasbtan taunts 96 Slaustics TOO IMCal Cl oma tice Sac ce oa act cai a ee ante ee acces hee 98 LV Analysis and LV Results tool Cards cccccccccceseeeeeseeeeeeeeueeeesseaeeeesaaeeeees 99 Calcium
34. settings for the volume display in the 3D viewer segment A number of predefined templates came with your system Advanced users may choose to adjust these to their own requirements or define their own set of 3D tem plates When saving a new or adapted template you decide whether to make it available for all users or save it under your own user account only Visage 7 Client View Window Template selection wr w X Turning fusion display on and off Visage 7 Client Tool cards Note If you edit and save one of the All users templates on the Visage server you change this template permanently and for all Visage 7 Client users in your net work The factory defined template version will be lost this way Templates Mew Color Template Call CT Color 1 Cally CT bone defa CT bone spec Simply click a template thumbnail on the tool card Or Drop down the list of suitable templates The tool card lists only templates that were defined for the modality or modalities of the da ta currently loaded on the View window After loading a template the volume display in the active 3D viewer is updated You can work with this volume display now or change individual display parameters if you wish Click Reset to return to the original 3D volume and revoke your changes Use these icons to maintain the list of templates available in your system Click the Save icon to save the 3D rendering and display settings cur
35. the mouse down to zoom out Mouse wheel Browses through the image stack in the MPR viewer CPR viewer lumen viewer or 2D viewer segments Right click Selects a viewer segment and calls up the viewer context menu or calls up the context menu of any other window section or control for which a context menu exists Or Selects or activates a control for which no context menu exists Right drag Pans the image i e moves the image in the viewer segment 54 Visage 7 Client View Window Two mouse buttons Left right drag Middle right drag Shift key mouse button Shift left drag Shift middle drag Control key mouse button Ctrl left drag Alt key mouse button Alt left click Alt left drag Alt middle drag Mac users Visage 7 Client Mouse operation Changes window levels in all viewers linked for joint windowing Move the mouse up or down to change the window center brightness Move the mouse left or right to change the window width contrast Browses through the image stack in the MPR viewer CPR viewer lumen viewer or 2D viewer segments This mouse button combination is not active in the 3D viewer segment Changes the segmentation threshold in lesion segmentation mode Zooms only the image in the selected viewer segment in or out Leaves images in linked viewers unchanged Always performs the default navigation function of the currently active viewer segment re gardles
36. the right of a field box Then specify your search string in the input box below the selected criterion For queries of your local database you can combine up to three additional filter criteria this way For queries on DICOM nodes only two additional filter criteria can be defined Acces sion Number and Study Description In addition you can click Study States and then select one or several study states in the dialog to be included in your search Clicking the Clear button resets this selection to in clude all study states Entering a text in the Label box will search for labels assigned to a study by means of the Context menu of the study series list You can search for more than one label and fine tune your search by a preceding sign label must exist or sign this label excluded 29 Query presets Study Browser Starting and resetting a search Click this button to start your query of the local database or the DICOM node whose tab card is currently shown in the study series list area EJ Click this button to remove all search criteria from the query boxes then start defining a new search Query presets The Presets bar contains the button New Preset which opens a dialog to define the current settings for example a specific query as a preset for the currently active us er This preset will then be shown as a button on the Presets bar You can W Preset e enter a name for the preset Name EE Z auto que
37. the value range are shown in the 3D viewer segment In MPR viewers tissue of this value range is highlighted blue 2 Identify the structure you want to remove Visage 7 Client View Window value range Visage 7 Client a 3D i Tool cards 3 Click the minus sign to the left of your object label in the objects list to subtract the selected structure from this object Tip Use the Objects control in the viewer controls of the 3D viewer and MPR viewers to adjust display options for any objects listed on the Edit tool card EJ ee O Blow 3D Too Data Range Min 201 HU vie 2976 Shrink 2x Shrink Exterior Cropped New Segmentation Defines the value range for any voxels to be shown in the 3D viewer or highlighted in one of the MPR viewers after you have clicked one of the following selection tools With the Connected Voxels in Value Range 3D tool you can click any point in the 3D viewer or an MPR viewer and the system will select all adjacent voxels of the same value range With the Encircle Voxels in Value Range 3D tool you can draw a freehand shape around a structure either in the 3D viewer or any of the MPR viewers When you release the mouse button the system selects all adjacent voxels of the pre defined value range within the freehand shape With the Encircle Voxels in Value Range 2D tool you can select voxels in a single slice image only You use this tool if you n
38. to attach a floating window to a stack of tool cards 1 Click the arrow button that points down upper right hand corner of a stack of tool cards A list of all available tool cards drops down 76 Visage 7 Client View Window Visage 7 Client Tool cards 2 Check more tools here to add their cards to your current stack A tool card can only be shown in one stack at a time Display 3D Colormap Structures Primary Dataset w 3D Colormap Overlay Dataset Bone Gray Ramp fall Calcium Cine w Display Edit LY Analysis LY Results Line Profile SUY Statistics Structures Templates Some tool cards require more window space than others You can therefore resize tool card stacks or the width of the entire tool card area 1 Click the line that divides two stacks of tool cards for example The mouse cursor changes shape 2 Drag the line up or down to resize the tool card above and below CT brain red CT cardiac Mi CT cardiac Y CT cardiac air ct bone mip cta imip If the tool card area is temporarily in your way you can hide it Click the arrow button between the image viewer and tool card section Or Uncheck View gt Show Tool Cards in the main menu to do so Depending on the protocol the tool card area may initially be hidden In that case click the arrow icon at the border of the window Or Select View gt Show Tool Cards in the main menu to show the tool card area T
39. to switch between the different ob jects assigned to the viewer Previous Phase of Time Series Next Phase of Time Series If you have loaded a time series use these icons to scroll through the phases Annotation and Measurement tools With these tools you can annotate and evaluate image information in slice images MPR viewers as well as in the 3D viewer Note however that measurements in the 3D volume of the 3D viewer segment are only possible in orthographic but not in perspective display mode Visage 7 Client View Window Toolbars Saving annotations For information about how to save annotations and measurements refer to Saving annotations and measurements NN Arrow Text Annotation Select this tool and click in an image segment to create a text annotation Or Click in an image segment hold the mouse button pressed and drag the mouse across the image to create an arrow plus text annotation straight line with arrow The Edit Annotation dialog box is automatically opened Subsequently you can also right click the arrow or annotation text and select Properties to open the Edit Annotation dialog box Refer to Editing annotations and Edit Annotation dialog box for information on how to move edit or format annotation texts Refer to Showing annotation text at a fixed viewer position if you want to freeze annotation text in a viewer segment Circle Annotation gt Select this tool and click in an ima
40. to the left and drag it onto a key or key com bination to the right to assign or reassign a tool to a keyboard shortcut or key combi nation Click with the right mouse button on an assigned tool and select Remove from the context menu to remove this tool from the keyboard shortcut or key combination amp Configure Function Keys Available Tools Function Keys FA F2 DS 3D Rotate Va Accept Registration X aX f et Align Centers gt Angle Measurement Alt Angles Between Disconnected Lines ic Kk A Anterior View Alphabetic Keys mex A B Apply to all Phases GR Automatically Link Viewers e Browse Slices Kod mm Center View a Calibrate image O m Circular ROI Ca Create 2D Region of Interest ROI tz Create 3D Region of Interest ROI TA Create Arrow Text Annotation Ca Create New 2D Structure Special Keys CA Create New 3D Structure lt eal Crop Box LP am Revert to System Defaults Tool Palette In the Configure Tool Palette dialog box you can assemble a toolbar with frequent ly used tools By saving this collection of tools for your own user account you create a personal toolbar or palette Click with the right mouse button on an assigned tool and select Remove from the context menu to remove this tool from the tool palette Visage 7 Client 129 General preferences Properties 130 W Configure Tool Palette Available Tools i 3D Rotate v
41. user profile You can click Save in user profile to save the changed parameters or reset to the factory defaults by clicking Reset user profile Save Send Initiates batching and a DICOM Send action A dialog is opened where several properties as in the Properties dialog can be reviewed and changed Select the receiving DICOM node under Destination Under Scout Images select the scout images you want to include as well as Show Mea surements and Annotations and Show Orientation Cube if required You can change the Series Number and Series Description or accept the defaults Click Make Default to save your settings and click Send to send the stack to the selected DICOM nodes Export Opens the Export dialog Depending on your selection in the Properties dialog the title bar of the dialog shows whether the stack will be exported as Grayscale reformatting or RGB Secondary capture Select the file format under Export as For a Grayscale export only DICOM Files dcm can be selected For an RGB export Image File JPG or PNG or Movie MPG can be se lected as well You can enter the path for the export file under Destination and a file name or accept the given one You can also Browse for a destination The file type is automatically appended The following Options are additionally available e You can change the Series Number and Series Description for DICOM files e You can select Burn in Patient Information and or Burn in
42. with this command Stores what is currently shown in the 3D viewer segment as a key view During your session you can return to this view using the Recall Key View menu entry or by pressing F11 F12 Previous Next Key View Note that key views are lost when you close Visage 7 Client or load new data To preserve key views save your session File gt Save Session or File gt Save Session As Allows you to select and redisplay one of the stored key views Allows you to delete a key view you created earlier during your session Shows or hides a 3D crosshair showing the orientation and position of the slices currently shown in the MPR viewer segments in the 3D viewer Shows or hides a box delineating the volume borders in the 3D viewer Turns on display of the centerline for vessel segmentation for this viewer segment Opens a submenu with commands for rotating flipping and centering the displayed volume Opens a submenu with alternative display options for the selected viewer segment Use this submenu to change the rendering technique in the 3D viewer segment for exam ple see also 3D rendering techniques in the 3D viewer Or use this submenu to select Smart Sampling which reduces artifacts in the volume dis play or to toggle between orthographic and perspective display see also Projection modes in the 3D viewer Opens a submenu in which you can detach which means temporarily remove a viewer from a linked viewers group Or
43. you can select or enter Type select whether you want to search by Study Date Date of Birth or Insertion Date i e the date when the data was transferred to the server From date To date specifies the search period Click in a date box with the cursor and en ter a date in the format YYYY MMM DD e g 2006 MAY 23 Or click the icon button to the right of the date entry box to open a calendar and select a start and end date from here 3 Click one of these buttons to select a default search period Today selects the current day as search period Yesterday selects the previous day as search period 1 Week selecis the last seven days as search period 2 Weeks selects the last 14 days as search period Allows you to search for patient and study data by modality You can toggle the modality search on and off by means of the checkbox If toggled on you can choose one of the following options 1 Check the boxes of all those modalities whose studies you are looking for CT comput ed tomography MR magnetic resonance tomography PT positron emission tomography PET US ultrasound CR computed radiography DX digital radiography MG mam mography XA X ray angiography 2 Enter any modality abbreviations in the Others box e g CT Multiple modalities are separated by a space e g CT PT MR Here you can specify further filter criteria Drop down a list of available criteria with the arrow icon to
44. After you have completed the last step the LV Results tool card is displayed as a floating window You can review your results now and export them to your report After you have just performed LV analysis the system cannot calculate the myocar dial mass automatically You need to identify the myocardium in your images manu ally first The LV tools support the physician in finding the left ventricle in the image data However the software cannot guarantee that the detected and displayed struc tures correspond to the left ventricle It is the responsibility of the user to check the plausibility and accuracy of the presented data 99 Tool cards LV Analysis 100 Short Axis View Edit Axes Step 1 View Window LY Analysis 3 8 wi ii Short Axis wiew 1 Place MFF c air in left ventricle Edit verity Find Axes Edit Axes 2 Segment left ventricle Lv Find L Clear Lw All Phases All Phases Find Ly Clear LY Current Phase 9 Current Phase 3 Time volume analysis Resuit Please verify segmentation results With the Next Phase Previous Phase buttons you can page through the phase images one atatime If you have moved or rotated your slice images use the Short Axis View button to return to this view quickly The button becomes active after you have finished the first step 1 Place MPR cross hair in lett ventricle Edit verity axes and valve level In this step you ar
45. Favorites list 2 Click Add In various help topics you will find links that will take you to more detailed informa tion about a subject Text links are highlighted by blue text color and underline Use the next and previous icons in the footer of each help topic to scroll through the online help system topic by topic The upper part of the help window shows a number of icon buttons Use these but tons to adapt the help window scroll through topics and print topics Shows the online help tab cards if they are hidden and then changes to the Hide button Frint Options 16 Hides the online help tab cards if they are shown and then changes to the Show button Returns to the previous topic Returns to the next topic after you have clicked Back Prints the current topic on the default printer Shows a menu with more help functions Visage 7 Client Starting and Ending the Program This section tells you how to start Visage 7 Client how to log onto the server and how to close Visage 7 Client properly Installing the Visage 7 Client Visage 7 Client Before you can start Visage 7 Client for the first time you must connect your client PC or Mac to the Visage server and install the Visage 7 Client software on your computer 1 Open your Internet browser 2 Enter the Visage server address and download in the Address Bar The Visage 7 Client download screen opens Visage PACS CS Windows Intern
46. If you intend to create movies on the Cine tool card of the Visage 7 Client the system will temporarily occupy local harddisk space during movie creation min 1 GB or more for large movie files Data protection and data security Data relating to individuals is subject to data protection In this regard please en sure compliance with all applicable laws and regulations in your country Visage provides extensive security mechanisms that help you assure data protec tion and data security On the administration platform the system administrator can also activate the audit trail option This supports the strict regulations concerning patient data protection and data security according to US law Note For security reasons it is not permitted to make changes to the Visage product and its database Contravention of this will lead to all guarantees being revoked and under some circumstances may even be violating applicable laws Access control and authentication Login and password 10 Each user must log into the Visage system with a user name and password The Visage server checks these entries Only if they match is access to the system granted Access authorization ensures that users can only view data for which they have access rights To ensure that user accounts and their passwords are effectively protected from un authorized access e passwords are encrypted and if this has been configured e passwords will expire e
47. In order to close Visage 7 Client ee Select File gt Exit from the Visage 7 Client menu bar Or kal Click Close window in the upper right hand corner of the window Mac users In order to close Visage 7 Client Select VisageCS gt Quit VisageCS from the Visage 7 Client menu bar 20 Visage 7 Client starting and Ending the Program Exiting Visage 7 Client Automatic logoff Visage 7 Client Or Click the red close button in the upper left corner of the application window If Visage observes no activity for a certain time default setting 15 minutes a mes sage box appears You are prompted to confirm that you wish to continue working If you do not answer you will be logged off automatically after a few seconds The li cense you were using is now available for another user Only the system administrator can change the automatic logout time Note If you do not continue working your current work is saved in a auto logoff session when you are logged off automatically 21 Exiting Visage 7 Client 22 starting and Ending the Program Visage 7 Client Getting Started This section describes typical features of the Visage 7 Client The Visage 7 Client workflow The general Visage 7 Client window layout Note In this user manual we assume that you have worked with Windows or Mac appli cation programs before You should be familiar with typical operating elements such as drop down and context menus and various
48. R P View Window CPR Vessel tools You use these tools to perform one of the following tasks e Definition and display of curved slices This implies that you define a curve through your volume and have Visage 7 Cli ent apply curved reformatting which shows a projection image of a curved extru sion plane defined by the vertices of your curve This view helps tracking curved structures such as the spine For curve definition you can either use the 3D viewer segment or MPR viewers or a combination of both In MPR viewers you can scroll slices while adding points vertices e Segmentation of vessels Semi automatic vessel segmentation implies that you identify a vessel in the 3D viewer or any of the MPR viewer segments and define at least the start and end point for the vessel segmentation Next you have the system segment the vessel automatically Finally you can evaluate the vessel in your MPR viewers or in the lumen viewer For a more detailed description of the procedures involved in vessel tracing and vessel analysis see also Vessels and Centerlines tool card Curved View Click this icon to show the curved slice viewer The curved slice viewer is shown in a new viewer segment As soon as you begin to click points along your curve a projection image is shown here Define Edit Curve Select this tool to begin curve definition A context toolbar appears in the lower right hand corner of your active viewer segment Now clic
49. View window and want to add more datasets rath er than replace the currently loaded data Add to view Select the dataset you want to add to your current session on the local database tab card or the tab card of an external medium or folder Click the Add to View button to add this data to an ongoing session This way you can for example load a previous study from a patient medium CD or DVD to compare it with a current study which you have already loaded from your database Only active on a DICOM node tab and only for users with permission to query and retrieve data from a remote DICOM node Select data on a DICOM node and click the Retrieve button to copy this data to the data base You can subsequently load the data onto the View window from there Only active on the Database tab and only for users with delete permission Select one or several studies or series in the study series list of the local database and click Delete to remove this data from the database If a patient study or series is displayed dimmed grayed out in the local study series list this means that the data cannot be loaded onto the View window The data can still be de leted You cannot delete data on remote servers Session management Visage 7 Client supports session management This means that you can save pro cessing and evaluation results before you end a session for example when you load new data or close the program When you return
50. Visage f Client User Manual gt VISAGE TMAGING C 1275 This software is CE compliant and is defined as a class Ila medical device in accor dance with Medical Devices Directive 93 42 EEC All product and company names are trademarks or registered trademarks of the re spective companies Some of the specifications described herein may not be currently available in all countries Please contact your local sales representative for the most current infor mation Caution US federal law restricts this device to sale by or on the order of a physician or properly licensed practitioner Visage 7 is the successor of the Visage PACS CS product family Information in this manual may be subject to changes without prior announcement ual Manufacturer US Distributor Visage Imaging GmbH Visage Imaging Inc LepsiusstraBe 70 12250 El Camino Real 12163 Berlin Germany Suite 230 Phone 49 0 30 700968 0 San Diego CA 92130 USA www visageimaging com www visageimaging com Support and Safety Contact Phone 49 0 30 700968 30 Email support visageimaging com Copyright Visage Imaging GmbH All rights reserved Document Version 29 00 Table of Contents Visage 7 Client system Overview 7 IUCN OSG USC ose cee aasn ncn ces men ctogzatontasiusestegavainesneansaeeieedousenaenco EaR 7 LICENSES managemen ites es teat rowel cas ses a earls ainsi an a ce Weaned oun teu Naelieeuthesind 8 System reguireMen S ccssar
51. Window Viewer segments 2D viewer The 2D viewer displays original slice images such as the scan images of a series or a topogram Depending on the active protocol the 2D viewer may be shown in a viewer seg ment which replaces one of the other segments or the 2D viewer is shown fullscreen Tip The 2D viewer allows you to scroll though a large number of images quickly Advanced image processing and analysis functions are not available in the 2D viewer these functions are only available in MPR viewer segments Image manipulation tools that do not make sense for original scan images are dimmed in the toolbar section of the 2D viewer Any image manipulation and evaluation options available in the 2D viewer can be accessed via mouse keys toolbar icons or the 2D viewer context menu 1 Tile 2 Tiles 3 Tiles 2x2 Tiles 3x2 Tiles 4x2 Tiles Current Prior 1 Current Prior 2 CTS Miller ANON Kurt p s A 2006 Jan 26 NCTIS2CTA B CTS Miller ANON Kur ps A 2006 Jan 20 NCTISZCTA B AUTOTESTOO1 09 23 26 MPR Batch Cine AUTOTESTOO1 09 23 26 MPR Batch Cinez Current 2 Current 2 CTS Miller ANON Kurt p s A 2O06 Jan 26 WCTIS2CTAB CTS Millar ANON Kurt ps A 2006 Jan 26 NCTIS2CTA B AUTOTESTOO1 09 23 26 MPR Batch Cine AUTOTESTOO1 09 23 26 MPR Batch Cinez Current 2 Current 2 Layouts toolbar Use the Layouts toolbar which is usually shown above the 2D viewer segment to select how many images you wan
52. a Accept Registration 1 Align Centers ri Angle Measurement A Angles Between Disconnected Lines A Anterior View Apply to all Phases R Automatically Link Viewers a a Browse Slices a Calibrate image mm a Center View Right click into viewer Tool Palette Show Tool Palette Show Viewer Context Menu Show Both Revert to System Defaults Visage 7 Client configuration You can choose whether a right click into the viewer will show only the tool palette only the context menu entries or both This dialog box shows the default settings for the majority of program functions and features The Properties dialog box also indicates whether a setting is a factory de fault or a system or user level configuration setting You can adapt configuration de tails here Moreover with the appropriate user privileges you can change the assignment of settings to the user or system level W Properties Property Annotations Summary in Corner of Viewer Bold Font Text and Line Color Red Green Blue Alpha Font Family Font Size px italic Font Line VVicth Freely movable text Text and Arrow Roald Fart 4 expand all collapse all lease note that properties highlighted in user profile Reset user profile False 111 255 255 255 111 255 255 255 arial 11 v True 2 False False will be overridden by this protocol even when they are saved in the Visage 7 Client
53. aaaeeeeesaeeeeesaaeesessaeeeseseneeesenas 133 Prioritizing and disabling protocols cccceeeececseeeceeeaeeeeeeeeeeeeeeesaeeeeeeaeaeeesesaess 133 DAVES Froroco Wiza O anie a a a 134 FICIO AGING Proloco S sedare a r a a 136 Index 137 Visage 7 Client 5 Table of Contents Visage 7 Client system Overview Intended use Visage 7 Client In this section you will find an overview of the Visage 7 product and its data securi ty concept as well as a brief introduction to the Visage user documentation Visage is a system for distributing viewing processing and archiving medical imag es within and outside health care environments The Visage server receives image data in DICOM format via the hospital network This provides universal connections to archives modalities and workstations The supported modalities are listed in the DICOM Conformance Statement Besides general image interpretation and processing tools Visage provides specific tool sets for several clinical applications including e CT MR angiography e g for vascular analysis and stent planning e Cardiac analysis including calcium scoring and functional assessment of cardi ac CT data e Neuroradiology including CT and MR brain perfusion analysis e Oncology including SUV analysis and lesion marking and analysis Visage is to be used only by trained and instructed health care professionals It can support physicians and or their medical staff in providi
54. ality The low resolution warning may appear while the dataset is still being loaded and the system generates full image quality or if a low streaming compression level has been selected Image processing in progress A yellow bullet in the lower right hand corner of a viewer segment indicates that the image shown in this viewer has not yet been updated with your latest image processing step The previous image is still displayed while image processing is performed in the background As soon as image processing is complete and the image display has been updated the yellow bullet disappears Note Do not use images that show a red or yellow bullet in the lower right hand corner of the viewer segment for primary diagnosis Wait until the bullet has disappeared see also View window main menu Miscellaneous warnings A yellow warning triangle in the upper left hand corner of the images indicates that warnings exist for this dataset Find out more about these warnings by clicking the yellow warning triangle if it is shown in your viewers For calibrated image types e g CT images a scale can be shown on the right edge of the viewer segments The scale looks like a small ruler and indicates centimeters or millimeters when you zoom in on an image If the image text is in your way during image processing you can either hide it alto gether or hide selected blocks of text information Use View gt Show in Viewer gt in the mai
55. an change the transparency settings for a tissue type You can change the tissue type description You can add or delete tissue type graphs Click Reset to return to the original 3D color map and revoke your changes Visage 7 Client View Window lan X Editing a color map Visage 7 Client Tool cards Use these icons to maintain the repertoire of color maps available in your system Click the Save icon to save your changes to a color map or create a new color map A dialog box opens Enter a color map name here and decide whether the new color map will be available for all users or for your user account only To remove this template from the list select a color map and click the Delete icon In order to move or resize the histogram 1 Click in the black area above or below the grayscale histogram and hold the mouse button down The mouse cursor changes shape it turns into a double arrow 2 Drag the mouse to the right or left to move the histogram and show areas to the right or left that were previously hidden Or Drag the mouse cursor up or down to condense or expand the histogram 3D Colormap Primary Dataset CT Bone Defaut fall me ee O O 1 E annann r In order to add or delete a graph 1 Right click next to the graph to open a menu 2 Select New Tissue to add a new graph Or Select Delete Tissue to delete the selected graph Or Select one of the listed tissue types for editin
56. arch a database for studies performed on one or several modalities E g check CT MR and DX modalities in the query section to show all items relating to any of these modalities You can toggle the modality search on and off by means of the checkbox All other entry boxes in the query section are filter criteria This means the more cri teria you define the shorter the hit list will be E g enter A for patient name to show all patients whose name starts with an A Or enter A for patient name and select to day for study date to show only those patients whose name starts with an A and who were examined today If you do not remember a name or number you are looking for you can use wild cards in your search E g type Mil in the patient name box to find Miller Milford Miltner or mil to find all the above and also Hamilton or AB 34 in the patient ID box to find AB1234 AB0034 and AB11345678 Even if you use wildcards you should always specify your search criteria as pre cisely as possible Rather general queries may yield a very long hit list which would require extensive scrolling Visage 7 Client Quality Assurance Query section Filter and search criteria Patient Date Modality Visage 7 Client First toggle between the Study and Order tabs depending on the search you want to perform The Query section will appear slightly different for each of them Searching on the Study tab produces results in the Performed P
57. assignment to viewer segments or accepting interactively made modifications e Accepting any global properties you made in the Preferences dialog boxes See also General preferences e Saving your new protocol or protocol modifications e Assigning a priority ranking to the new or modified protocol See also Prioritizing and disabling protocols Save Protocol Select File gt Save Protocol to call up the Save Protocol wizard wizard Note Because Visage 7 Client expects you to base any protocol definitions on a pre defined protocol the Save Protocol command is dimmed if no image data are cur rently shown on the View window amp Save Protocol Protocol Name CT Angio AUTOMATCH landscape Based on CT Angio AUTOMATCH landscape Comment save modified Protocol Access cy Monitor Matching Criteria A Study Series Matching Criteria g a Tools Layout and Viewer Properties Image Assignment to Viewers Global Properties eu Protocol properties marked with have been modified The overview page of the Save Protocol wizard indicates which display settings you have already changed interactively on the View window These categories are shown in bold type and are marked with an asterisk Visage 7 Client 135 Protocol configuration Visage 7 Client configuration Procede through the various pages of the Save Protocol wizard and click the Save Protocol button when you are done Reloading protocol
58. at a later time you can load the session again and resume your work or present your results to colleagues 34 Visage 7 Client Study Browser Recent or study sessions Loading a session Auto logoff session Session sharing Visage 7 Client Session management Tip A session stores the following information How many and which datasets were loaded at the time the session was saved Protocol and display settings Key views incl annotations and measurements Segmentation results such as 3D ROIs or vessel segmentation results Structures and contours Cardiac analysis results Note Session information is temporary data Sessions are stored on the Visage server as long as the studies they refer to are stored on the server Once a patient or study is deleted from the database session information is lost Deletion of patient and study data may be triggered manually or automatically when the hard disk is full Automatic deletion of study data affects the oldest stud ies on the server If session management has been enabled for your user account the lower right hand corner of the Study Browser displays a session list Use the Show My Recent Sessions button to show a list of your most recent ses sions for all studies in the session management section of the Import window Or Click a study in the study series list to show only sessions of this study in the ses sion management section Double
59. ation options described in this section but you may not be able to access all of these options e Prioritizing and disabling protocols e Save Protocol wizard Prioritizing and disabling protocols Use the File menu of the Study Browser of View window File gt Preferences gt Protocols or the View window Protocol menu Protocol gt Configure Protocols to open this dialog box Visage 7 Client 133 Protocol configuration Visage 7 Client configuration amp Protocols Fitter Match currently loaded primary exam Monitors Match primary priors Active Protocols Only Name Modalities Body Parts Priority Active Level CTA Cardiac Function system CT with prior MPR 1L system CT with prior MPR 2L system Lung CT with prior MPR 1L system PET CT 1 prior separate modalities system v v v v CT Angio AUTOMATCH landscape system v v v PET CT combined modality system v Cancel Only protocols with a checkmark in the Active columns will be considered when a user loads data and the system selects the protocol best suited for the selected da ta Moreover only active protocols are listed in the Protocols menu and presented to users for manual protocol selection The Protocols dialog box also allows you to prioritize protocols and to enable or disable protocols Protocols with a high priority ranking are more likely to be select ed by the system when a user loads data onto the View window Protocols wi
60. axial slice native thin slice image 2 Click the Calcium Scoring button on the Calcium tool card In your MPR viewers all areas with an intensity of more than 130 HU are high lighted blue 3 You are now expected to scroll through the slices of your series and assign high lighted blue areas to arteries Click the label button for an artery on the Calcium tool card Then click on a blue highlighted area in your image or draw a lasso click and drag Scroll on to the next slice and repeat these steps The calcium score is updated every time you assign a new highlighted area to an artery Calcium m Calcium st Multti slice Mode RCA PDA Count Score 1 Lh LAD rc aa POA Ad na ma Total 1 Equivalent Agatston Score Report Export cs Click this button to have the system identify areas with a HU value of 130 or more in your dataset The button is active only if the active MPR viewer shows an axial native thin slice image Check this box if you want artery assignment to be applied to adjacent slices as well 103 Batching tools LM LAD CX Results table Export coi View Window Artery label buttons Click a label button first and then assign it to a highlighted area in an image The results table lists the coronary arteries the number of lesions found according to Agat ston Score and the calcium Score which is equivalent to the Agatston Score Click the Report button to c
61. been installed on recipients computers before they click the email link Tip Remember to save recent changes File gt Save Session before sending a ses sion link File gt Email Session Link Preview images Windowing preview images Resizing the preview area 36 When a dataset is selected in the local database a preview is displayed automati cally in the preview area In case of 3D datasets this preview displays the central Slice If multiple series are selected a preview image is shown for each of these se ries On remote DICOM nodes previews are available only if the selected series has al ready been sent to the Visage server If a session is selected in the session management section a screenshot of the View window is shown in the preview section The screenshot shows the View win dow with the session data at the time when the session was saved For a better overview you can window preview images Click a preview image hold the mouse button down and drag the mouse up down to change the window center or brightness or right left to change the window width or contrast You can change the size of the preview window area and the study series list by dragging the split bar that separates these window areas up or down You cannot resize individual preview images Visage 7 Client View Window You use the View window to display images and evaluate image information Window layout Depending
62. can change the location of a toolbar by dragging it across the window and dropping it wherever you prefer it to be shown When you drag a toolbar to the left right or bottom edge of the window a new toolbar section appears there When you drag and drop a toolbar anywhere else on the window it is shown in a floating window some of the functions and options that are represented by toolbar icons can also be called up with keyboard shortcuts These keyboard shortcuts are active even ifa toolbar or icon is currently not displayed in any of the toolbar sections on the win dow Tip A number of keyboard shortcuts have been predefined for the Visage 7 Client These keyboard shortcuts are indicated in brackets after the function name in the tool description tables in this user manual Or select Help gt Keyboard shortcuts in the main menu to show a list of these keyboard shortcuts Note however that users with appropriate user rights can change the assignment of keyboard shortcuts for their own user account or on a system wide basis see also Visage 7 Client configuration Keyboard Shortcuts This means that the key board shortcuts list in the main menu as well as the keyboard shortcuts indicated in this user manual may no longer be correct for your system Working with toolbar icons Tool tips Active function 56 All icons are assigned tool tips A tool tip explains the function of an icon Position the mouse cursor on an icon and
63. click a session in the session list to load its dataset s and session settings onto the View window If the system logs you off automatically after an extended period of no user interac tion the currently loaded dataset s and all your preliminary processing and evalua tion results are automatically saved in an auto logoff session An auto logoff session is shown in red and in the topmost position in the session management section of the Study Browser after you have logged on again Tip Open the auto logoff session immediately after you have logged on again and de cide whether to save it in a user created session When you are logged off auto matically a second time a new auto logoff session is created and the previous session is overwritten You can use session management to share your work with colleagues When saving a session the system prompts you to indicate if you want to save this session under your own user name or if you want to share it with other users Ses 35 Preview images Study Browser sions that you made available for all users are marked with shared in the session management box of the Study Browser Shared sessions can also be sent as session links to colleagues via email When your colleagues receive such emails all they need to do is to double click the at tached link to open the Visage 7 Client and display this session Note Sharing sessions via email requires that the Visage 7 Client has
64. clicked outside the contour you can use the nudge tool to push the contour line in and reduce the area defined by the contour When you click inside the contour you can push the contour line out and increase its area Use the Undo icon on the context toolbar if necessary to undo contour editing step by step Click OK when you have finished refining the contour Visage 7 Client 97 Tool cards 98 oe New 3D Calculate volume Statistics View Window Click the New 3D button to create a new 3D structure This requires that you draw contours in more than one slice image and that you scroll through your image stack between contour definitions Use the tools in the contour toolbar in the lower right hand corner of the active viewer seg ment as described above to refine your contours Click the Delete button to remove selected structures or contours from the list Click the Calculate Volume button to calculate the volume mm of the selected 3D struc ture as well Click this button again each time you refine one of the contours that define a 3D structure Click this button to open the Statistics tool card Statistics tool card The Statistics tool card performs statistical analysis of all ROIs and structures that you defined in your primary dataset These are A volume that you cropped using the Freehand Crop tools The table if you cropped it using the Remove Table tool Bones that you segmented using the B
65. cted images in a Visage Web Client image view G er The button only becomes active once snapshots have been sent to the local da tabase Visage 7 Client 115 Report editor toolbar Export Window Report editor toolbar The toolbar section comprises several toolbar sections File With the icons of the File toolbar or the commands of the File menu you can e Create a new report e Print your report or show a print preview e Create snapshots of your report pages one per page The generated report snapshots will be shown on the thumbnails section on the left side so that you can export the report pages as images save them in the Visage image data base or send them to any DICOM partner e Create a PDF version of your report e Create a Word document e Send the report to the RIS depending on configuration RIS integration e Close the report you are currently working on Templates When you create a new report you can select one of the report templates stored in your system eport Template all If you have made changes to your template that you would like to reuse in future re ports click the Save icon next to the template drop down list You can either over write an existing template or create a new one now Format Actions Standard Use these two toolbars or the commands of the Format menu to perform one of the following text formatting operations e Format selected characters or words as bold text
66. d all Studies for this Patient Assign study to groups Assign study to users 32 Loads one or more selected studies or series to the View window Adds one or more selected studies or series to the View window If this would result in data from different patients being shown on the View window a safety query will be displayed Loads the selected series with a dynamic protocol and shows all series side by side See also Viewer segments in section View window main menu Loads the selected series with a dynamic protocol and shows all phases of time series side by side See also Viewer segments in section View window main menu Shows all studies of the patient of the selected study Assigns the selected study to one or more user groups thus granting only them access to the study The assignment can be revoked by the same means Assigns the selected study to one or more users thus granting only them access to the study The assignment can be revoked by the same means Visage 7 Client Study Browser Study Labels Delete protec tion DICOM Send DICOM Quick Send Media Export Visage 7 Client Study series list Opens a dialog to show labels of a study and create new or assign existing labels to studies so they can be quickly located for example for conferences or a second opinion 1 Select a patient or study and right click it 2 Select Study Labels 3 Inthe dialog now opened check one or mo
67. down click one of the handles and drag it in or out to shrink or enlarge the shutter Bone tool card The Bone tool card helps you remove bones from CT datasets of the entire body or of the legs Visage 7 Client can automatically delete and remove the pelvis and spine and the bones in the legs Other bones cannot be segmented automatically Segmentation of bones with the tools of the Bone tool card is saved on the server automatically No user interaction is required in this The next time you load a dataset in which you performed bone removal in an earlier session you can also re load your segmentation results You can now apply them to the data again with the Remove Leg Bones icon of the Remove toolbar or the option Load Pre Computed Segmentation on the Bone tool card Visage 7 Client View Window Segmentation al gorithm Find Aorta Compute No Bones Bones Only Reset Visage 7 Client Tool cards The bone tool card supports the physician in finding bone structures in the image data However the software cannot guarantee that the detected and displayed struc tures actually correspond to the bones of the pelvis spine and the bones of the legs It is the responsibility of the user to check the plausibility and accuracy of the presented data Run Segmentation Algorithm Remove Pelvis and Spine Remove Bones in Legs Place MPR cross hair in aorta Find Aorta Compute Select which bones yo
68. duct documentation The Visage product documentation distinguishes between three user groups and the tasks that these groups typically perform e Clinical users These users access the Visage server from a Visage Web Client or Visage 7 Cli ent in order to review 2D 3D or report data The Visage Web Client and Visage 7 Client user documentation addresses this user group e System administrator The system administrator of the hospital will perform system maintenance and adapt server configuration and database settings to changes in the system and network environment This user group works on the administration platform The Visage administrator documentation addresses this user group e Service personnel This user group will install the system and subsequently perform initial system configuration This group will need the installation manual for system installa tion and the administration documentation for initial system configuration In this section you will find an overview of the available product documentation as well as information on how to work with the Visage manuals and online help sys tems 12 Visage 7 Client System Overview Overview of the product documentation User and administrator documentation User documentation Administrator documentation Visage 7 Client The Visage product documentation addresses the information needs of each of these user groups The Visage Web Client and Visage 7 Client user
69. e Visage 7 Client download screen you can also download the user man uals for the Visage 7 Client and Visage Web Client as pdf files Starting Visage 7 Client If your system and user account have been configured for so called IWA Integrated Windows Authentication starting the Visage 7 Client software is very straightfor ward Double click the Visage 7 Client icon on your desktop Or Select Programs gt Visage 7 gt Visage 7 Client from the Windows Start menu The Visage 7 Client application program opens and the Study Browser is shown in the foreground Visage 7 Client Starting and Ending the Program Starting Visage 7 Client from the login dialog box Starting Visage 7 Client from the login dialog box If your system and user account have not been configured for IWA Integrated Win dows Authentication or if you want to switch over to a different user interface lan guage you start the Visage 7 Client from the login dialog box Windows users p Select Programs gt Visage 7 gt Login Dialog from the Windows Start menu Double click the Visage 7 Client icon on your desktop The Visage 7 Client login dialog box opens amp Visage CS Thin Client Login Login User Mame John Doe Password Language English C Integrated Windows Authentication Administration Mac users For easy access you should move the Visage client application to your dock Click the Visage 7 Client icon in your dock Or
70. e expected to move the crosshair to the left ventricle in one of the MPR viewers Click the Find Axis button when you are done The system will now find the long and short axes of the left ventricle As a result the system will show the short axis view in one MPR viewer and long axis views in the other MPR viewers In the long axis views the valve level is indicated as a pink line You are now expected to check the correct indication of the long axis and valve level in all phase images Page through the phase images to do so If the axis or valve level are not indicated correctly in an image you can adjust them click the pink line in one of the slice images and drag it up or down Use the navigation crosshair in one of the slice images to move or rotate the axes click close to the center to move the axis or click far from the center to rotate it Decide whether to apply these adjustments to the currently displayed phase image alone or to all phase images Apply to all Phases button in the context toolbar Click Apply in the context toolbar in the lower right hand corner of the active viewer seg ment when you have finished your adjustments Visage 7 Client View Window Tool cards Step 2 MESTERT Clear Li All Phases All Phases Find Li Clear Ly Current Phase CCurrent Phase Click one of the Find LV buttons to have the system segment the left ventricle either in All Phases or in the Current Phase your phas
71. e images The segmentation results are indicat ed as shaded areas in the slice images Page through the phase images once again to ver ify that segmentation yielded correct results in all phases if you chose this option If you do not agree with segmentation results in one or several images Click Clear LV and readjust the valve level and axes as described above Click the Find LV button again when you have finished your adjustments Or Use the Edit tool card to edit the object LV manually You can add or remove voxels in single or multiple time steps Do not forget to unlock the LV object before you start editing Step 3 3 Time olume analysis Results Click the Calculate Perfusion button when you are satisfied with the segmentation results in all images The LV Results tool card is now shown LV Results L Results Regional Ejection Fraction LY Yolume Over One Heart Cycle Heart Rate 6a cy 100 ml ES ED c c Volume 52 ml 49 49 ml 3330 mlimin editing tools to define 80 100 0 Global Volume When displayed as a floating window the LV Results tool card consists of three segments a summary section a curve display section and a section showing results in the AHA American Heart Association bull s eye view When you display the LV Results card in one of the tool card stacks only one of these segments can be shown at a time Global Volume T Regional Volume l Wall Motion Use the drop down selectio
72. e this icon to show or hide your curve in the images in the MPR viewers and in the vol ume in the 3D viewer segment Brain Perfusion tools For brain perfusion studies Visage 7 Client provides tools for performing perfusion analysis The icons are sorted according to the workflow from left to right Display tMIP Click this icon to show or hide the temporal MIP In a temporal MIP of a CT dataset the brightness of each pixel in the image indicates the maximum pixel value in any of the time steps for this pixel In MR datasets tMIP shows the minimum pixel value This helps to show contrast filled vessels particularly clearly Define Artery Next select Define Artery on the toolbar and click on the main artery of the brain in the tem poral MIP image The point where you clicked is marked as a ROI and an uptake curve for this ROI is shown in the viewer The update curve for the artery is displayed in red Define Vein Next select Define Vein on the toolbar and click the main vein of the brain in the image The uptake curve of the vein has been added to the graph The uptake curve for the vein is displayed in blue If the graph is in your way click it and drag it to where it does not hide im portant image information 71 Toolbars 72 ye View Window Calculate Perfusion Click the Calculate Perfusion icon on the toolbar to show the following functional images in the result images viewer segments mean transit time MTT
73. ed this icon the warning triangle disappears from the image segments Align Centers Click this icon to have Visage 7 Client align the centers of the bounding boxes of the two datasets Reset Registration Click this icon to undo any manual or center alignment The two datasets are now registered in the same way as they were right after loading Viewer Linking tools Toggle Linking Some protocols allow linked navigation in multiple viewers When such a protocol is active you can use this icon to turn viewer linking on and off When you navigate in a linked viewer the slice images in all linked viewer segments are updated accordingly Link Current Position When a side by side protocol is active you can link viewers on a certain landmark in the two datasets e g a lesion bone or calcium segmentation Position the crosshairs on the landmark in both viewers and then click the Toggle Linking icon Reset Viewer Linking Shows linked datasets in the same way as when you first loaded them Link Display Properties Synchronizes window level adaptation and display of thin or thick slices in all linked viewer segments Automatically Link Viewers Click this icon to link viewers and the datasets displayed in these viewer segments automat ically Edit Viewer Linking Click this icon to link viewers and the datasets displayed in these viewer segments automat ically 69 Toolbars Curved planar reconstruction 70 CP
74. eed to work with extreme precision and proceed slice by slice With the Define Contour in 3D tool you proceed in the same way as when defining 3D structures with the Structures tool card As soon as you click this tool a context toolbar is shown in the active MPR viewer segment Select Elliptical Contour or Freehand Contour in this toolbar and draw a shape around the structure in this slice image Scroll on to the next slice image that shows the structure in question particularly clearly and also define a contour Click OK to finish contour definition Note that with the tool Define Contour in 3D you are expected to draw a shape as closely as possible around the boundary of your structure as it is shown in your slice images This is because the Contour tool considers any voxels within your shape and not only those of the value range defined on the Edit tool card 95 Tool cards View Window Grow Click this button to increase your selection by one step Shrink Basic workflow 96 Use the Grow 2x button to increase your selection by two steps Click this button to shrink your selection by one step Use the Shrink 2x button to shrink your selection by two steps Click this icon to clear a selection Use the plus sign in the objects list to add a selection voxels highlighted red to a object Or Use the minus sign in the objects list to remove a selection voxels highlighted red from a object Click these icons
75. el will be shown in a list You can select an entry in this list and use the context menu to perform the following actions e make a private label public or vice versa e delete a label e assign it to a button on the labels toolbar Label buttons If a label was assigned to a button it is shown on the Labels toolbar Miscellaneous tools In this section you will find a description for additional tools and toolbars that are not contained in any of the standard toolbars by default Most likely these tools will be available as separate toolbars which have been defined by the active protocol Magnifier Use this tool to be able look at details in the displayed images more closely without having to zoom the entire image Select the tool and click in an image to enlarge a portion of that image just as if you were applying a magnifying glass Request original lossless data from server If a red dot can be seen in the lower right corner of an image this image has been loaded from the server in compressed form Press the HD button to force updating the image with lossless original data from the server Visage 7 Client View Window Visage 7 Client Toolbars Scroll Page by Page Click this icon to use the wheel mouse for browsing images In a 2D viewer segment that shows one image turning the mouse wheel will scroll one image at a time If the active viewer segment is a 2D viewer and several images are shown in the 2D viewe
76. elected studies to a destination to be selected You can perform the following actions e check whether you have selected the correct Patient e view the Actual data size of the export file s e select a Destination in the list box e browse for an Export Folder e enter a name to the Media Folder or accept the the one suggested by the system e specify the Media Size selecting either CD or other medium e specify whether to Include Media Viewer to view the data on the CD without additional software Autorun MediaViewer when the medium is inserted and Uncompressed only to save in that way Click on Make Default to save your settings for subsequent media exports if required and click on Export to start the export process 33 session management Study Browser Loading retrieving or removing data This icon is active on the local database tab and on remote DICOM nodes or external drive and for data that has already been transferred to the database Select one or several studies or series in the study series list and click the View button Or If you want to load only one study or series simply double click it in the study series list to load the data onto the View window When session management has been enabled for your user account double clicking a study loads the most recent session associated with this study Double clicking a series loads image data only but no session information If you have already loaded data onto the
77. elps you with vessel analysis as it allows you to trace one or several vessels in your dataset and name them which will help you with reporting Vessel segmentation and analysis are performed in two steps e Vessel tracing Visage 7 Client offers two alternatives or modes for vessel tracing a semi automatic mode and a manual mode In most cases you will use semi automatic vessel tracing and click to select two or more points along a vessel and then have the system trace the vessel If the system cannot trace and segment the vessel correctly you can reset tracing return to curve definition select more points and repeat automatic tracing You will use the curve editing tools on the Vessel tool card or on the CPR Vessel tools to do so In semi automatic mode the system will slightly readjust the points you clicked for ex ample move a clicked point to the vessel center and trace the path of the vessel automatically Vertices you selected for semi automatic vessel tracing are shown as green dots If semi automatic vessel tracing fails to produce adequate results for example be cause of poor image quality you can revert to manual tracing mode Hold the Shift key down while you click vertices Manually selected points are shown as blue dots and are placed exactly where you clicked When you start vessel tracing the system connects all blue dots with straight lines and does not attempt to readjust points or trace vessel paths automatically
78. ent protocol from the Protocol menu There are additional ways to change the images and display parameters in the View window Visage 7 Client View Window Viewer segments Change the arrangement of viewer segments and load image data into these viewer segments manually See also nteractive arrangement of viewer segments and image data Or Select different rendering parameters for MPR viewer segments or the 3D segment from the context menu or from the viewer controls See also Viewer controls 3D viewer context menu and MPR viewer context menu Or Select additional tool cards from the Tools menu See also View window main menu and Tool cards Or Add toolbars to the toolbar section See also View window main menu and Toolbars Viewer segments Linked viewers Visage 7 Client The Visage 7 Client View window is subdivided into several viewer segments For example if you have loaded a single thin slice CT dataset it may be presented us ing three MPR viewer segments and one additional 3D viewer segment The active viewer segment is indicated by a highlighted viewer frame Tip Show crosshairs in all viewer segments This will help you identify the position and orientation of the displayed slices in one MPR viewer with respect to the slices in the other MPR viewers and the 3D viewer segment See 3D viewer context menu and MPR viewer context menu for how to enable crosshair display Viewer segments can be
79. eports for the study you have analyzed on the View window or to save send or export snapshot images from here Export Basic workflow When creating reports or saving or sending images you proceed in this order 1 Load your study series or volume dataset onto the View window 2 Show or create the relevant slice images aid 3 Create snapshots of every image you wish to preserve g 23 4 Send results of an LV analysis or a calcium score analysis to the Export window In order to create a report 1 Select a template on the Export window optional 2 Drag snapshots onto your report page s 3 Add text 4 Save and print your report In order to save or send snapshot images 1 Select the snapshot images you wish to save or send on the Export window 2 Click this button to save the images on your local computer or in your network Or Click this button to save the images in your database or on another server in your DICOM network Visage 7 Client 113 Export Window Overview of the user interface fe Report editor toolbar Snapshots Report text 114 Visage 7 Client Export Window Snapshots Snapshots While analyzing images on the View window you create new slice images and add measurements and annotations In order to document your results you can create snapshots of such images with the Snapshot Active Viewer S or Snapshot All Viewers Shift S tools on the View window Snapsho
80. er to these sections e Study Browser e View Window e Export Window e Quality Assurance Note If Visage 7 Client was called from another application the Study Browser may not be available 25 The general Visage 7 Client window layout Getting Started Menu bar Context sensitivity Common commands for Windows users File Help Common commands for Mac OS users VisageCS Help 26 The Visage 7 Client main menu bar contains a number of drop down menus for se lection of program options or functions The Visage 7 Client program features a context sensitive main menu Context sen sitivity means that the contents of the menu bar depend on the Visage 7 Client win dow that is currently shown in the foreground For example the Protocol and Tools menus are available on the View window but not on the Study Browser and Ex port window These menus and commands are available on all Visage 7 Client windows Exit Closes the Visage 7 Client Online Help Shows the Visage 7 Client online help system Audit Warning Displays a dialog box which informs users that their activities may be mon itored This command is shown only if the audit trail license has been installed on the server Keyboard shortcuts Shows the list of keyboard shortcuts for Visage 7 Client About Opens a message box with information about the currently installed program ver sion the accessed servers and information about the current program
81. ertion date today local database tab 4 Select the retrieved data from the local database tab card and load it onto the View window Or 1 Select the tab card of an external drive or directory 2 Select the data on this tab card and load it onto the View window Or Click Add to View to add the data to an ongoing Visage 7 Client session If this tab card is not shown in your Study Browser or if it does not show the data you are looking for 1 Select File gt Import DICOM Directory or File gt Import DICOM Files from the main menu 2 Select the drive and directory where the data is stored in the Import DICOM dia log box and click Choose or Open 3 Select the data on the tab card of the external drive or directory and load it onto the View window or select Add to View to add the data to an ongoing session 2 Query section Overview of the user interface Study Browser Study Browser menu Toolbar Loading retrieving or removing data Query presets Query Study series list section Preview images Session manage ment CJ C Query section Modality search Filter criteria Wildcard search 28 Before you start defining filter or search criteria for a database query select the da tabase drive or directory you wish to search by clicking the corresponding tab above the study series list Any query will only apply to the database whose tab card is currently shown in the foreground The query
82. es 116 Reset Registration icon 69 Reset Viewer Linkage icon 69 Resizing images 60 Retrieve button 34 Retrieving data from a DICOM node 34 Right icon 59 Rotate Clockwise icon 60 Rotate Counterclockwise icon 60 Rotate Flip Images tools 60 Rotating slices 58 volume 58 S Save Session 110 Save Session As 110 saving snapshots 113 Scale 40 Scoutlines MPR viewers 50 Segmentation 3D ROI statistics 98 bones 92 Edit tool card 94 object definition 94 removing parts of the volume 67 structures 96 vessels 91 Select As Baseline Phase 49 Sending snapshots 113 Session Auto logoff 35 email link 110 loading 110 most recent 35 new 110 save as 110 saving 110 study 35 Session management 34 loading session 110 new session 110 save session 110 Session sharing 35 Shortcuts keyboard 56 mouse operation 54 Show in Viewer 40 141 142 Show Toolbars 57 Showing hiding bounding box 45 50 centerline 45 50 crosshair 45 49 fullscreen mode 45 49 image text 40 111 partial crosshair 50 reports from the RIS 45 49 scale 40 tool cards 76 111 toolbars 57 111 viewer controls 45 49 Shutter 92 Slice thickness 47 Snapshot Active Viewer icon 66 Snapshot All Viewers icon 66 Snapshot and Cine tools 66 Spherical ROI icon 63 Stacked Batching 104 Standard anatomical view
83. ess these preferences can also save their settings Again depending on their user privilege settings these changes will be effective for their own user account only or on a system wide basis Tip If you cannot access some of the commands and dialog boxes described in this section this indicates that your user account has not been assigned the appropri ate user rights Talk to your system administrator about the organization of user privileges in your institution All configuration options are accessible from the main menu some configuration options are available on all windows while others can be acessed from the View or Study Browser window only General preferences Visage 7 Client Select File gt Preferences from the Study Browser or View window to drop down a submenu with the folllowing configuration options e Window Level Presets e Properties Tool Palette e Properties e Monitor Configuration In order to be able to access these configuration dialogs you need to be assigned to a user level with the right to manage properties on a user or system level Monitor configuration is available to all users irrespectively of their user level 127 General preferences Visage 7 Client configuration Monitor Configuration If you are working with more than one monitor this configuration dialog box allows you to define which Visage 7 Client window will be shown on which monitor amp Monitor Configuration Click int
84. et Explorer o GA Y mF http imyserver mydomain org download v t X max Pz w visage PACSICS 1 amp 8 e roa Visage 7 Download Thin Client Software gt gt Visage CS ThinClient 7 0 0 0 Download Web Client Software gt gt VisagePACS WebClientInstall en msi Download user documentation gt gt VisageWebClient Online Guide EN pdf gt gt VisageWebClient User Manual EN pdf gt gt Windows Vista WebClient Installation Instructions EN pdf lt lt back to login page 17 Starting Visage 7 Client Windows users Mac users Starting and Ending the Program Click the download link for the Visage Client exe Windows under Download Thin Client Software This will start the Visage 7 Client setup procedure which will install the client soft ware on your PC Follow the instructions in the setup windows After program installation Visage 7 Client will be available in the Windows Start menu and an icon will have been created on your Windows Desktop Click the download link for the Visage Client dmg Mac under Download Thin Cli ent Software The dmg file is automatically unpacked and becomes an application file app You can now double click the file to open the Visage client 1 Copy or move the file into your Applications folder to install it permanently 2 Drag amp Drop the application file into the dock to create a shortcut Tip From th
85. ew Window Mouse operation Advanced Visage 7 Client users can perform many of the most frequent image ma nipulation tasks directly in the viewer segments with the left middle or right mouse button This way you do not have to move the mouse to activate or switch tools To operate Visage 7 Client primarily with the mouse you need to distinguish be tween clicking and dragging Visage 7 Client has functions assigned to clicks with the left middle or right mouse button Dragging implies clicking the left middle or right mouse button and moving the mouse while you hold the mouse button down If your computer is equipped with a wheel mouse you can use it for scrolling by turn ing the wheel or you can click the wheel this way it functions as the middle mouse button Some functions require that you keep the Shift Ctrl or Alt keys on your keyboard pressed while you click or drag the left middle or right mouse button The following tables list all functions assigned to mouse buttons combinations of mouse buttons and combinations of keys plus mouse buttons Single mouse button Left click Selects a viewer segment or performs a function i e the function selected by the currently active tool Left drag Performs the default navigation function of the currently active viewer segment or the func tion of the currently active tool Middle drag Zooms the images in all linked viewers Move the mouse up to zoom in or move
86. ex sections help you locate a topic quickly To help you find and interpret the appropriate information the following visual orien tation aids are used here e Operating steps Single step actions are presented as plain text 1 Operating steps in sequences of actions are numbered e Bold text Names of windows menus and functions are shown in bold typeface Sections of text given particular emphasis are also highlighted in bold type Tips notes and warnings are specifically highlighted in the text Tip Tips provide additional useful information about a topic Tips for example help you organize your work more efficiently Note Notes mark text that you should pay special attention to A note may for example emphasize a piece of information relating to the safety of functions but where no danger is involved Caution is used to indicate the presence of a hazard which can cause personal in jury to a patient or damage to the equipment Visage 7 Client System Overview Overview of the product documentation Information on using the online help systems Calling up online help Help Online Help Audit Warning Hotkeys About Mac users Windows users Tab cards Contents Indes Search Visage 7 Client The Visage Web Client and Visage 7 Client user interfaces and the Visage adminis tration platform feature an online help system each Call up the Visage 7 Client online help w
87. failed login attempts are recorded and multiple failed login attempts will cause a user account to be locked Note Recording logins and other actions only makes sense if all users on the system have their own user names and passwords Visage 7 Client System Overview Multi session operation Auto logoff Service access permissions Audit trails Visage 7 Client Data protection and data security A user may log on to Visage more than once from a single or multiple client ma chines This allows users to work from more than one clinical workplace simulta neously and view the same data there Each session makes use of and thereby blocks one license Visage can be configured so that a logged in user is logged off from the system after a configurable period of time with no user interactions This prevents licenses from being unnecessarily blocked and stops any unauthorized persons accessing data if a user has logged on but has forgotten to log off again Remote access for service purposes must be granted explicitly It is therefore up to you if and to what extent you wish to grant access rights to service e Full Access Service has read and write permissions This means that service personnel can analyze problems and can solve these problems or change settings Service ac cess is logged e Limited Access service has read permission only e No Access Service has no access Note Please note that with full acce
88. ftware requirements for Visage 7 Client PCs or Macs e Operating system and software Microsoft Windows XP 82 bit and 64 bit editions Microsoft Windows Vista 32 bit and 64 bit editions Microsoft Windows 7 32 bit and 64 bit editions Mac OS X 10 5 or Mac OS X 10 6 e Computer processor Intel Pentium IV or equivalent e Main memory 1 GB RAM e Graphics card Any graphics card that supports a screen resolution of at least 1024x768 pixels and true color For optimum performance on very high resolution monitors we recommend graphics cards supporting OpenGL acceleration For details on qualified cards please contact your Visage Imaging representative e Monitor Single monitor or up to four monitors for viewing and one or more additional monitors for study browser reporting or quality assurance All monitors used for viewing image data must have the same pixel resolution and orientation portrait or landscape e Other For latency free operation in local area networks LAN we recommend the use of Gigabit Ethernet In order to be able to use the client in wide area networks or through the Internet the Visage streaming technology has been optimized to support even very slow networks down to a bandwidth of 512 Kbit s However for smooth operation we recommend a bandwidth of more than 6 MBit s and a latency of less than 60ms Visage 7 Client 9 Data protection and data security System Overview Temporary harddisk space
89. g In order to edit a graph 1 Click a graph to select it 2 Drag the boxes to the left or right along the bottom line of the histogram to change the window center and width of this tissue type 83 Tool cards View Window Or Double click the boxes along the bottom line or the apex or apices to change the color definition of the graph Or Drag the boxes up or down to change transparency settings Or Click in the tissue description text above the histogram and edit this text T eT Primary Dataset Primary Dataset CT Bone Defaut fall CT Bone Default Call soft tiz2ue soft tlz2ue Mew TISSue Delete Tissue we bone contrast air colon we sof tissue ii 127 224 aa a a a a a aaan O O BE lt annn nn r n Gai 127 224 O O O O o o o e ee Bme O a 5 annann r 1 In order to rename a tissue type 1 Click a tissue graph control point or line to select it The name of the selected tissue type is shown above the graph section 2 Select this text in order to overwrite it 84 Visage 7 Client View Window Cine tool card for MPR viewers image stack or time series Batching Position Increment Best 3D Quality Update All View ers gt UL Visage 7 Client Tool cards Cine tool card With the controls on the Cine tool card you can animate the display of the MPR and 3D viewers Depending on the type of data that has been loaded and the selected vie
90. ge 7 Client displays a message that reminds you to check the correct alignment of the two datasets and confirm it manually Unless you do so a warning triangle will be shown in the images throughout your entire session Close the message box and use the icons of the Fusion Registration toolbar to check adjust and confirm correct spatial alignment of your dataset pair Tip Prior to aligning datasets manually you should window the two datasets in such a way that prominent structures are clearly visible e g a bone This will help you overlay the two corresponding images correctly Manual Registration Click this icon to enter manual alignment mode In this mode the two datasets are displayed overlaid The primary dataset is shown in magenta and the overlay dataset is shown in green in the active viewer An outlined cross also appears in the MPR viewer segment Click the center of the cross hold the mouse button down and drag the green layer so that corresponding structures in the green and magenta layer are exactly overlaid Release the mouse button when they are Or Click one of the ends of the cross The cursor changes shape and indicates rotation Click and hold the mouse button down to rotate the green overlay layer Visage 7 Client View Window Visage 7 Client T S amp S io Toolbars Accept Registration Click this icon after you have finished aligning your datasets manually Once you have click
91. ge segment to create a circle with a predefined radius Or Click in an image segment hold the mouse button pressed and drag the mouse across the image to create a circle with your own radius You can right click the circle and select Set Size as Default to define this radius as your own default The Edit Annotation dialog box is automatically opened when a new circle is created Subsequently you can also right click the circle or annotation text and select Properties to open the Edit Annotation dialog box Refer to Editing annotations and Edit Annotation dialog box for information on how to move edit or format annotation texts Refer to Showing annotation text at a fixed viewer position if you want to freeze annotation text in a viewer segment Distance D Select this tool click where you want to start your distance measurement hold the mouse button down drag the mouse across the image and release the mouse button at the end point of your distance line Or Create a line that consists of several segments start the first segment press the Shift key before you release the mouse button at the end of the first segment Hold the Shift key pressed while you draw the other segments Release the Shift key before the last click The distance is indicated in mm millimeters Display the Line Profile tool card tool for an intensity profile or HU value profile for CT of your distance line Refer to Editing annotations for i
92. gmented automatically because of poor image quality for example Use the Measure Lesion tool from the Lesion context toolbar to measure the diameter of a lesion in the images of one or both studies Or Select Measure Lesion 2 Diameters to measure both the horizontal and the vertical di ameter of a lesion Note that your measurements must be perpendicular In order to classify a lesion according to the RECIST standard Click a lesion to select it Drop down the list of standardized lesion labels next to the Classify Lesion icon to select one If you have marked several lesions in one or two corresponding datasets Use the Next Lesion Previous Lesion tools in the context toolbar to scroll through all le sions marked in your dataset You can create snapshots for your report now for example 13 Toolbars HME Labels ad my Cases 74 View Window Labels tools Labels button Opens a dialog to show labels of a study and create new or assign existing labels to the cur rently open so it can be quickly located for example for conferences or a second opinion 3 Click the Labels button 4 Inthe dialog now opened check one or more existing labels in the list box you can filter this list by means of show public and or show private OR Create a new label by entering a name activating Create Private or Create Public to assign it to your own account or all users The selected label s or new lab
93. he active viewer If you activate a viewer showing a different dataset the values in the SUV tool card are updated SUY Patient s weight kg 54 000 Patient s height m 1 620 Patient s sex Female Radionuclide haltlite sec Radionuclide total dose Bq Tracer injection Time 14 20 00 Scan series time Time 15 33 18 Reset to DICOM values Defaut Data Window lay 2 0 4 0 Measured Activity Bom SU for body weight g ml SUW for lean body mass James g ml SUY for body surface area DuBois om 2ml Make Default Check if this data has been entered correctly and add missing information if you want to cal culate SUV for lean body mass or SUV for body surface area Check and if necessary add missing information on half life dose injection and scan time start Use this button if you have changed data and want to reset it to the information stored in the source files Adjust the SUV data window used for initial display in SUV based protocols Select the unit you want your system to use for displaying radionuclide activity in the pa tient s body Choose between becquerel or Standardized Uptake Values or select Counts for data acquired with Phillips scanners 89 Tool cards 90 Make Detautt View Window Stores the default values for the initial data window as well as for the preferred SUV type in the global settings for this user Vessels and Centerlines tool card This tool card h
94. he three different methods of batching e Stacked Batching e Horizontal Rotational Batching e Vertical Rotational Batching Toggle RGB Grayscale Click this icon to switch the image generation mode between Grayscale reformatting or RGB secondary capture 107 Batching tools View Window Batch Send Clicking this toolbar icon initiates batching and a DICOM Send action A dialog is opened where several properties as in the Properties dialog can be reviewed and changed Select the receiving DICOM node under Destination Under Scout Images select the scout images you want to include as well as Show Mea surements and Annotations and Show Orientation Cube if required You can change the Series Number and Series Description or accept the defaults Click Make Default to save your settings and click Send to send the stack to the selected DICOM nodes Export Opens the Export dialog Depending on your selection in the Properties dialog the gt title bar of the dialog shows whether the stack will be exported as Grayscale reformatting or RGB secondary capture Select the file format under Export as For a Grayscale export only DICOM Files dcm can be selected For an RGB export Image File JPG or PNG or Movie MPG can be se lected as well You can enter the path for the export file under Destination and a file name or accept the given one You can also Browse for a destination The file type is automatically appended
95. hick SIICES cccccseeeeeceeeeeeeeseeeeeeeeeeeeeesaeaeeeeseeeeeeeas 48 MPR Viewercontext MENU scenai annia daara aa E T 48 2D VIEWS enrik ee eee a a ee 51 Interactive arrangement of viewer segments and image data c cccseeeeeees 52 HAY OULTOOID AD seis eGo suerecat inlet can lseeete anne stacaas encase vente cranentdeess sattecsemteceuee 52 image Senes tool CAN G xs eusiacet sailed oes E nl Ok eile te 52 Mouse operatorie a tucant eye a eects 54 SOONG AN Seenen a a sara a te 56 WVOKKING Wit tooDar ICONS seirena a a a ea e E 56 Showing or hiding toolbars cece cc ceeeeceeeseeeeeeceeeeeeceaeeeeeeeeaeeesseeeeeeesegeeeeseeeeeeeas 57 Slandard 100S onres E 57 Navigati n LOOIS raie a a a ea a 58 OSM WOM LOO S aa A a a 59 WAGE SIZ OC 1OOIS rernaeni seo 59 Visage 7 Client Table of Contents Rotate Flip Images tools ccccceccceceeeecneeeeceeeeecseeeeeeeaeeessueeeseeeeesseeeesseeeeesaaess 60 DataSet NAVIGON Tool wisi caaueaesinl A We eR Men eslebtans 60 Annotation and Measurement tools ccccccccecceeeceeseeeeeeeeeeeeeeeeesaeseseeeeseeeees 60 ShapShot and GING OOS ssh ulaeteevsivertiwceiedevene a ied eetatiaee 66 COPDING TOO Si a5scecsuscthsevdee Stim A A E A E a O EE 66 REMOVE TOO rn E E E 67 Fusion Registration tOOIS cccccccccceseeeceeeeeceeeeecseeeeeeeseeeeeeeeseeeeeseeeeesaesesseneeens 68 Viewer LINKING 1OOIS siriar e a A len 69 CPR VeSSel tOOlS eari a a a a aa EEs 70 Bran Pernun TOOS
96. iew gt Streaming Compression allows you to select a compression lev el for image transfer from the server to the client computer Select a compression level depending on the network you are working in and on the image quality you require the system will remember your selection e Auto selects a compression level that has been optimized for the current net work bandwidth and latency characteristics e Lossless Only transfers only losslessly compressed data with full image quali ty Select this option for fast networks for example in local area networks LANs Your server needs to be configured to support this function e Medium applies a medium compression level Select this option for example in a slow LAN or a wide area network WAN e Strong applies a high compression level for fast data transfer at the expense of image quality Select this option for example if you are working in a slow or very busy network Note If images are displayed with reduced image quality as a result of your streaming compression this is indicated by a red bullet in the lower right hand corner of the window Wait until the red bullet has disappeared to assure sufficient image quality for primary diagnosis see also Low resolution warning Protocol configuration The full scope of protocol configuration options requires a combination of various user level settings Therefore even though you may be able to access some of the configur
97. indow from the Help menu The first topic of the Visage 7 Client online help system is displayed The Visage Client will launch the PDF viewer of your system in order to view the on line documentation Search and navigation functions depend on the PDF reader that you are using on your system The remainder of this section does not apply Use the various navigational features of the online help system to search for the in formation you need The left half of the Visage 7 Client online help window shows four tab cards for quick access to the help contents This tab card contains a table of contents similar to that of a printed book 1 Double click the book icon to display a topic and show subheadings 2 Click the page with question mark icon to display the text of a help page in the right half of the help window You can search for index entries here 1 Enter a word to search for Or Scroll through the alphabetical index 2 Double click an index entry to display the information about it This tab card permits a full text search 1 Enter a word to search for 2 Press the RETURN key All help topics containing this word will be listed 15 Overview of the product documentation Favorites Links to other topics Browse sequence Help window toolbar System Overview On this tab card you can set bookmarks for help topics that are of particular interest to you 1 Display the topic you want to add to the
98. ion on how to move or edit measurement graphics 63 Toolbars gt Editing annotations Edit Annotation dialog box Showing annotation text at a fixed viewer position 64 View Window Pixel Value Select this icon and move the mouse over an image in an MPR viewer segment The pixel value of the cursor position is shown as image text in the lower left hand corner of the view er segment The value changes as you move the mouse In CT images the pixel value is given in HU Hounsfield Units In other image types the units depend on the information stored in the DICOM data Cobb s Angle With this tool you can measure Cobb s angles in spine datasets Or use this tool to measure the angle between lines that intersect outside the visible image area You can modify an annotation or measurement even after you have finished draw ing it Click the annotation graphic to reselect it and move the entire graphic Or Move an end point of a line by clicking and dragging it to a new position Or Right click an annotation or measurement graphic and select Properties from the context menu to edit display properties Or Delete the annotation graphic with the Del key on your keyboard Or Click a distance line that is in your way during image review Hold the mouse button down and drag the line to where it is no longer in your way The end points of the original measurement are indicated as dots Note that a line p
99. k the vertices of your curved slice in any of the viewer segments The vertices and the curve will be shown in all viewer segments that display this data Use the Show All Vertices icon in the context toolbar to toggle display of all vertices that you have created so far or only those in slices that are close to the currently displayed slice Use the Undo icon in the context toolbar of the active viewer segment to remove the last vertex Or use the OK icon to finish curved slice definition Clear Points Use this tool to delete a curve definition Toggle Centerline Use this icon to show or hide your curve in the images in the MPR viewers and in the vol ume in the 3D viewer segment Visage 7 Client View Window Vessel segmentation P UM L a hy rN Ss lt Visage 7 Client Toolbars Define Edit Curve Select this tool to begin curve definition A context toolbar appears in the lower right hand corner of your active viewer segment Click at least two points along your vessel to define the vessel segment you wish to review Curved View Click this icon to turn display of the curved slice viewer on or off Lumen View Click this icon to turn display of the lumen slice viewer on or off Cross Section View Click this icon to show a cross section of your vessel in one of your MPR viewer segments Use the context menu in this MPR viewer segment to show the shutter as well Toggle Centerline Us
100. lay of the primary dataset on and off Select the primary dataset from the drop down menu arrow button to the right Histogram and Shows the histogram of the primary dataset coler map Use the slider right below the histogram to adjust the window settings for this dataset Or Drop down a list of available color maps with the arrow button to the right of the histogram and select a suitable color map Overlay Dataset With this checkbox you turn display of the second dataset on and off This dataset will be overlaid over the primary dataset Select the overlay dataset from the drop down menu arrow button to the right Histogram and Shows the histogram of the overlay dataset color map Use the slider to adjust the window settings for this dataset or select a color map from the drop down menu Fusion slider This slider allows you to fade between the primary and the overlay datasets If you move the Slider all the way to the left only the primary dataset will be visible If you move it all the way to the right only the overlay dataset will be visible 80 Visage 7 Client View Window Display card in non fusion mode MPR and 3D viewers Dataset selec tion Histogram and color map MPR CPR Lu men viewers User defined color maps Visage 7 Client Tool cards 3D Volumes 1 IFR ee ee ee Overlay Dataset PT BOB 299 PET Ve Always Highest Resolution Thickness 5 0 mm Allows to select the datase
101. let it rest there for a short time A brief explanation of this icon appears Some icons start functions immediately others allow you to activate a processing mode Visage 7 Client View Window Drop down icon bars k Crop Box LL J Crop Corner T Crop Plane hoe Crop Slab oo Toolbars When a processing option is selected and therefore active the corresponding icon is displayed with a gray background Some icons represent a drop down icon bar This is indicated by a small triangle pointing downwards 1 Click exactly on the small triangle in the lower right hand corner of a drop down icon Or Click a drop down icon and hold the mouse button pressed for a little while 2 Move the mouse cursor along the icon bar until it points to the function or image processing tool you wish to select 3 Click an icon on the drop down icon bar to select this function or option For frequently used functions the program now replaces the drop down icon in the toolbar with the icon you last selected This makes it the preferred icon in this drop down icon bar The next time you wish to activate this function all you have to do is click this icon you no longer have to drop down the icon bar Icons that represent rarely used functions will stay in the drop down icon bar and not move up to the top level Showing or hiding toolbars Standard tools Visage 7 Client If the currently displayed selection of toolbars d
102. linked which means that image manipulation steps are au tomatically applied to all linked viewer segments and not only to the one that was active when you made the changes As a rule all MPR viewer segments that show images from the same dataset are linked Linking of viewers is defined in the cur rently active protocol Linking affects one or several image manipulation steps depending on how linking has been defined in the protocol For example slice browsing is synchronized in all viewers that have been linked in a translation group and zooming is synchronized in all viewer segments that belong to the same zoom group Users can edit the ways in which viewers are linked either for the duration of an entire session or only tem porarily for the next image manipulation step Use Attach Detach Viewer or Edit 39 Viewer segments Image text and warning symbols Scale Showing hiding image text 40 View Window Viewer Linking from the viewer segment context menu or the Viewer Linking tools to change the way viewers are linked Aside from image information the viewer segments contain information about the loaded data in the form of image text and icons The following symbols in images alert you to the fact that an image is shown with re duced image quality or that warnings exist concerning the displayed images Low resolution warning A red bullet in the lower right hand corner of a viewer segment indicates reduced image qu
103. ls Mirror Mode Use this icon to toggle mirror mode on an off Multiphase tools Subtract baseline Subtracts the baseline image from a time series See also Additional tools for time series analysis Visage 7 Client View Window Visage 7 Client Toolbars Lesion tools Lesion tool With these tools and context toolbar you can mark lesions segment lesions and evaluate and compare lesions in a current and earlier study for example To evaluate and compare lesions in a current and prior study proceed as follows 1 Load the two studies onto the View window and show corresponding images side by side Tip Linking the two viewers will help when you scroll while reviewing the datasets 2 Click the lesion tool on the toolbar A context toolbar is shown in the lower right hand cor ner of the active viewer segment 3 Use the Segment Lesion tool to segment and evaluate a lesion 4 In the corresponding image of the other study either segment the lesion as well or use the Mark Lesion tool to mark a spot if no lesion is visible in this dataset If you have segmented lesions in both images lesion statistics are shown which include le sion growth information In order to grow or shrink a lesion segmentation Hold the Shift key down click in the image and drag the mouse across the window The le sion segmentation grows or shrinks and the lower threshold level for the segmentation is shown If a lesion cannot be se
104. ment Click anywhere in the viewer segment hold the mouse button pressed and drag the mouse to rotate the 3D volume in the direction of the mouse move ment Use any of the standard orientation icons or keyboard shortcuts Anterior A Posterior P Left L Right R Head H Foot View F to reset rotation MPR viewer segments Click the point in the image that is to be the center of rotation Hold the mouse button pressed and drag the mouse to rotate the image plane New slice images in non standard orientations are created in the process If the orientation labels and orienta tion cube are currently shown in a segment they indicate the new image orientation Use Reset Slice Orientation F9 to return to the original image orientation Pan F3 Select this icon and click and drag the mouse across an MPR viewer or 3D viewer segment to move the image within the segment Zoom F4 Select this icon click in a viewer segment hold the mouse button pressed and drag the mouse cursor up to zoom in or down to zoom out Or use the percentage box in the viewer controls to change the image display size Visage 7 Client View Window i5 O Visage 7 Client Toolbars Window Level F5 Select this icon click a viewer segment hold the mouse button pressed and drag the mouse cursor left right to change the window width contrast or up down to change the window center brightness While the Window Level tool i
105. n box in the lower left hand corner of the tool card to select a dif ferent view of your LV analysis results Click the Report button to send your LV Results views to the Export window where you can include them in your report Visage 7 Client 101 Tool cards Summary Global Volume Bull s Eye View Regional Vol ume Endocar dial Distance Wall Motion Bull s Eye Mo tion Myocardial mass calculation Edit X i if 102 View Window Enter the heart rate of your patient here The cardiac output value is updated automatically Also adjust the system s selection of the end diastolic ED and end systolic ES phase with the sliders if necessary Here you find a graph of the total LV volume over one heart cycle View the results of the calculation of regional ejection fractions in a bull s eye view The segments in this bull s eye display correspond to the AHA classification Move the mouse cursor over a segment to show the segment designation as a tool tip Or right click anywhere in the bull s eye view for a context menu that allows you to toggle be tween results view and segment ID view In this segment or tool card view you will find the stroke volume curves of the various LV re gions Initially the curves of all regions are shown If you find this view hard to read right click any where in this section for a context menu that allows you to select and deselect region
106. n menu See Visage 7 Client configuration Viewer Properties Shows or hides the tool cards section of the window Allows you to select which toolbars to show or hide Allows you to select which information will be shown as image text in the viewer segments See Visage 7 Client configuration Reset All Warnings See Visage 7 Client configuration Render Settings Opens a window showing the latest report for the selected study Opens a window showing the currently loaded study as well as prior studies of this patient Selecting one of more of these by means of the checkbox and clicking Load opens them on the View window See Visage 7 Client configuration UI Appearance See Visage 7 Client configuration Streaming Compression Allows you to select a protocol from the list Default is the protocol that the system considers best suited for the currently loaded vol ume data Under Protocol gt All gt you find a complete list of all protocols defined in your system sorted by monitor configuration Returns to the preset session protocol in case another protocol was used in the meantime The protocols that the system considers best suited for the currently loaded data are listed first See Visage 7 Client configuration Prioritizing and disabling protocols Allows you to select and show tool cards 111 View window main menu View Window 112 Visage 7 Client Export Window You use the Export window to create r
107. n menu to hide or redisplay specific blocks of image text in all viewer segments Or Use View gt Show in Viewer gt Toggle All or the keyboard shortcut Spacebar to hide or redisplay all image texts in all viewer segments Visage 7 Client View Window Viewer controls Viewer segments Tip When working with a small window size and low window resolution it may not always be possible to show all image texts and image icons correctly Texts are truncated and icons the scale or a color bar may be shown on top of each other Maximize the program window and switch to fullscreen mode for display of all image information Each viewer segment has a number of controls within easy reach along its lower border You can use these controls to toggle or select display options relevant for this viewer segment 60 Wit SEO Thin MPR wv 1 0mm Click the arrow icon to the right of a viewer control to drop down a selection list Or Click a value and overwrite it to change the window center width slice thickness or zoom percentage of images for example Tip lf the viewer controls are temporarily in your way you can hide them Right click in a viewer segment and deselect Viewer Controls in the context menu 3D viewer segment Visage 7 Client The 3D viewer segment displays a 2D projection of a 3D volume You can choose between several volume rendering techniques and display modes in the 3D viewer segment In the 3D
108. name 3 Select the value range of the structure you are about to segment either by using the value range slider or by entering grayscale values or HU values for CT data in the min max boxes 4 Click one of the selection tools above the value range slider e g the Connected Voxels in Value Range 3D tool The system switches into a mode in which only voxels with grayscale values de fined by the value range are shown in the 3D viewer segment In MPR viewers tissue of this value range is highlighted blue 5 Select voxels in the 3D viewer or one of the MPR viewer segments Your selection is shown red 6 Use the Grow or Shrink buttons to enlarge or reduce your selection if neces sary 7 Click the plus sign to the right of your object label in the objects list to add the selected structure to this object 8 Use the context menu in the objects list section of the Edit tool card to control the display of segmented structures in MPR viewers Outlined in MPR Filled in MPR or Opaque in MPR If your selection included more voxels than appropriate you can subtract them from an object 1 Point the mouse to the object you have just created and select Select this ob ject from the context menu 2 Select the Lasso tool hold the Shift key down and circle the section you want to remove from the selection Or 1 Click one of the selection tools above the value range slider Only voxels with grayscale values defined by
109. net ic resonance tomography NM nuclear medicine PT positron emission tomography PET US ultrasound SC secondary capture images 2 Enter any modality abbreviations in the Others box e g CT Multiple modalities are separated by a space e g CT PT MR 121 Presets bar Quality Assurance Fields Here you can specify further filter criteria These are specific either for a Study or Order search Drop down a list of available criteria with the arrow icon to the right of a field box Then specify your search string in the input box below the selected criterion In addition you can e click Study States and then select one or several study states in the dialog to be included in your search on the Study tab Clicking the Clear button resets this selection to include all study states OR e select an order status from the Status drop down list on the Order tab Starting and resetting a search Click this button to start your query of the local database or the DICOM node whose tab card is currently shown in the study series list area Click this button to remove all search criteria from the query boxes then start defining a new search Presets bar The Presets bar contains the button New Preset which opens a dialog to define the current settings for example a specific query as a preset for the currently active us er This preset will then be shown as a button on the Presets bar You can W Prese
110. nformation on how to move or edit measurement graphics Visage 7 Client 61 Toolbars View Window The accuracy of distance measurements Is 2 pixels Larger errors can occur if the image is displayed with reduced matrix size that is if not every original pixel is shown on the screen due to zoom out For optimum accuracy we recommend Zooming into the structure of interest as much as possible The accuracy is further limited by the physical resolution of the acquisition itself If the monitor used for display does not permit exact pixel selection the inaccuracy can be greater still Angle Select this icon click in an image segment hold the mouse button down and drag the mouse to draw the first leg of an angle Click when you have reached the vertex and draw the second leg Refer to Editing annotations for information on how to move or edit measurement graphics Angle Two Lines Select this icon click and draw two separate lines in your image If the lines intersect the program calculates both the acute and the obtuse angle If the lines do not intersect in the viewer segment the program calculates only the acute angle Refer to Editing annotations for information on how to move or edit measurement graphics The accuracy of angle measurements depends on the length of the shorter of the two angle legs The longer the angle legs are the better the accuracy For example Length of shorter angle leg measurement error
111. ng their own diagnosis for medical cases The final decision regarding diagnoses however resides with the doctors and or their medical staff in their own area of responsibility Although the web and thin client technologies allow the software to be run on a vari ety of hardware platforms for diagnostic purposes the user must make sure that the display hardware used for reading the images complies with state of the art diag nostic requirements and currently valid laws Only DICOM for presentation images can be used on an FDA approved monitor for mammography for primary image diagnosis Only uncompressed or non lossy compressed images must be used for primary im age diagnosis in mammography License management System Overview License management Licenses Upgrade Every Visage installation comes with a license code Without it the software will not run on the server The license code serves as copy protection and controls which product options are enabled This includes e The maximum number of DICOM connections for calling importing data from the network onto the Visage system and for sending data from the Visage system e How many users may access data on the server simultaneously via Visage Web Client or via Visage 7 Client also referred to as thin client Different viewer types require different licenses e The maximum data volume on the server e Activation deactivation of audit trails e The availability of the
112. nking tools 69 Viewer segments 39 Visage 7 Client Index Volume cropping 66 removing parts 67 removing the chest wall 68 removing the leg bones 68 removing the table 68 rotating 58 VRT 42 VRT diffuse 42 VRT specular 42 W Warning symbols 40 Wildcard search 28 Window layout 24 38 Window Level linking 69 Window Level icon 59 Workflow 23 X XA X ray angiography 29 Z Zoom icon 58 Visage 7 Client 143 Index 144 Visage 7 Client VISAGE TMAGING Visioneering Science for Life Copyright Visage Imaging GmbH European Headquarters Visage Imaging GmbH LepsiusstraBe 70 12163 Berlin Germany phone 49 0 30 700968 0 For contact information and a list of our world wide office locations visit www visageimaging com US Headquarters Visage Imaging Inc 12250 El Camino Real Suite 230 San Diego CA 92130 USA phone 1 888 338 4724 1 978 319 4641 Visage Imaging is a wholly owned subsidiary of Pro Medicus Ltd www promedicus com REF 750 7 0063 07 00 02 Pro Medicus Headquarters Pro Medicus Ltd 450 Swan Street Richmond 3121 Victoria Australia phone 61 3 9429 8800
113. ntext toolbar appears in the lower right hand corner of the active viewer segment For semi automatic vessel tracing green dots Click two points along your vessel to define the vessel segment you wish to review Or For manual tracing mode blue dots Hold the Shift key down while you click points along your vessel Click Clear if you have made a mistake and want to start again Click Trace large for large vessels e g carotids or aortic vessels or click Trace small for small vessels e g coronary arteries Visage 7 Client traces the vessel between the end points of your curve automatically now If automatic vessel tracing is unable to trace the vessel correctly return to Edit mode to re fine your curve definition Click to add more points click an existing point to show images of this point in MPR viewer segments or Shift click existing points to select them without up dating image display in the MPR viewer segments Drag a selected point to move it 91 Tool cards Vessel analysis View Window After you have had the system segment your vessel you can analyze it using the shutter view and the lumen view Click Curved View in the lower left hand corner of the Vessel tool card to show a new view Curved 92 CPR LUM E j l wit Lumen E j it Shutter er segment with a projection image of a curved plane defined by the vertices of your curve definition Curved view allows you t
114. o helps service personnel with initial system configuration tasks immediately after system installation or update The Administration Manual This document is available as a pdf file on your program CD DVD You can print out this document if you prefer reading on paper The administration platform Online Help System The Visage administration platform features a context sensitive online help sys tem The context sensitive help topics explain the parameters you will find and the settings you can make on the various configuration windows Whenever rele vant background information on selected topics is also given in the online help system 13 Overview of the product documentation System Overview Service documentation Release notes Installation instructions are available for Visage Imaging service personnel only Release notes contain additional useful information about the software They focus on technical details Information on using the Visage manuals Document structure Layout conventions Tips notes warnings 14 In order to help you locate relevant information in the Visage manuals quickly they are subdivided into chapters In the Visage 7 Client user manual each chapter addresses a specific window or tab card of the Visage 7 Client application program The chapter on starting and ending the program and the Getting Started chapter address new users of the sys tem specifically The Table of Contents and Ind
115. o rotate around a vessel for example Click Lumen View to show a new viewer segment Lumen view helps you locate areas of interest along your vessel and navigate to these slic es quickly Simply drag one of the sliders to the slice you would like to review This slice is now shown in the MPR viewers Use the lumen viewer context menu to show the distance between the sliders Segment Length Dragging a slider also turns Cross Section view on which replaces one MPR viewer seg ment Use cross section view to measure the vessel cross section with the Distance D tool Measurement results are shown in the lumen viewer next to the slider of the active cross section Use the keyboard shortcut E to toggle cross section display of the two sliders in lumen view Once you have measured the vessel cross section in the images of the two slider positions use the context menu in the lumen viewer to turn display of the percentage of the Stenosis on and off If the shutter is not already shown in the cross section viewer select it from the context menu With shutter mode active You will navigate along the selected vessel when you browse slices in the segment with the shutter One of the sliders in lumen view will follow your movement You can rotate the vessel in Lumen View with the viewing angle handles in shutter view Click and drag these handles to look at the vessel from a different angle You can resize the shutter Hold the Shift key
116. o the monitors in order to change the assignment of function to the monitors View Fullscreen JY Docked Browse Fullscreen Docked Report Fullscreen Docked QA Fullscreen J Docked Reset to Default Cancel Window Level Presets In this dialog box you can define Window Level Presets for image types Either en ter the relevant parameters or copy settings from the currently active viewer amp Configure Window _evel Presets Preset CR Preset 1 Name vv Preset Name Name Fixed value range Center 200 Width 500 Min 300 Max 700 Automatic WWL based on histogram Min 0 04 Max 99 98 Value range embedded in DICOM image 1 2 3 last Copy values from active viewer Reset Save Preset Window Level Presets can be called from a drop down menu in the viewer con trols below each viewer segment and via the available shortcuts 1 2 3 4 C 60 Vi 360 Thin MPR v Default 0 DICOM 1 Shitt 1 DICOM 2 Shift 2 MyPreset 1 h VVindow Level Presets 128 Visage 7 Client Visage 7 Client configuration General preferences Keyboard Shortcuts Visage 7 Client comes with a set of predefined keyboard shortcuts for frequently used functions and tasks You can display this list by selecting keyboard shortcuts from the Help menu In the Configure keyboard shortcuts dialog box you can adapt the assignment of keyboard shortcuts to your own preferences Select a tool in the Available Tools list
117. oes not contain the icon or icons you are looking for you can show more toolbars Use View gt Show Toolbars in the main menu to show or hide toolbars Or Right click in the toolbar section of the window to open a menu with all available toolbars Check additional toolbars here Toolbars group icons by function frequency of use and suitability for specific datasets and diagnostic problems Which toolbars are available after you have load ed your data depends on your active protocol and on your general configuration The active protocol defines which toolbars are shown directly after you have loaded data and also which toolbars are available in the first place 57 Toolbars 58 I View Window This user manual describes the standard toolbars of the Visage 7 Client and the tools these toolbars contain In addition to these standard toolbars you may find ad ditional toolbars with icon groups that were defined for a specific protocol Navigation tools Default Navigation F1 The default navigation tool is set to browse slices when the active viewer segment is an MPR CPR lumen or 2D viewer and to 3D rotate when the active viewer segment is a 3D viewer Tip With the Ctrl key you can return to the default navigation tool temporarily Default navigation will be active for as long as the Ctrl key is pressed When you release the key you return to the currently selected program function 3D Rotate F2 3D viewer seg
118. on your selection of data the View window will be shown with a different window layout This window layout is defined in a so called protocol The system will preselect a different protocol for data of different modalities and an atomical regions and depending on the monitor configuration and how many series you load onto the View window at a time If you prefer another protocol you can se lect a different one from the Protocol menu Overview of the user EN aKe MPR viewer segment MPR viewer segment Tool cards PC 0 PW 400 T MPR 8 0mm Foo ed oe G E A E eee Visage 7 Client 37 Protocols Protocols Protocol assignment Protocol definition Changing the View window content 38 View Window Protocols define the layout of the View window and the display parameters for the loaded images When a user loads one or several studies series or volume datasets onto the View window the system automatically selects a suitable protocol to display the data De pending on the system and protocol configuration the system uses a combination of several matching criteria to select the protocol best suited for the loaded data e Monitor configuration Different protocols can be defined for different combinations of monitors and screen resolutions e Study and series criteria Protocol matching criteria usually include the modality or combination of modali ties that acquired the data For example a CT series may be sho
119. one tool card Chest wall ribcage which you removed with the Remove Chest Wall tool Vessels that you selected with the Vessels and Centerlines tool card Structures that you defined on the Structures tool card Objects which you defined on the Edit tool card Lesions segmented volumetrically with Segment Lesion tool from the Lesion tools Visage 7 Client View Window Compute Export coi Visage 7 Client Tool cards Statistics Area Volume Perimeter Voxel Mean Std Dey Min Max ADAD tem em em Count HU Hu IHU HU Mame 2D ROIS 20 5 529 9 9 HES 557 456947 161 74 3D ROl 4 Cropped Selected Rows Compute Export Cs Export CSW Selected Click Compute to have the system evaluate your ROls and structures In the columns 2D 3D you can tell whether the evaluated ROIs are 2D area or 3D volume ROIs If you want to continue evaluating the results of your ROI evaluation with another program e g Excel you can export them as a comma separated list Use the Export CSV button to export all your results or select Export CSV Selected to ex port the statistics of selected rows i e selected ROIs or structures only LV Analysis and LV Results tool cards The LV Analysis tool card helps you with the analysis of the left ventricle in cardiac CT time series which show the heart in various phases of one heart beat This tool card guides you through an LV analysis step by step
120. ons in front of the entries to expand or collapse the list Name of the patient Patient s identification number Patient s date of birth Patient s sex M F O QA status of the study Possible values are NOT SCHEDULED SCHEDULED COMPLET ED and DISCONTINUED Job number of the patient in the HIS RIS hospital or radiology information system ID of the study Modality or modalities used to examine the patient Body part examined in this series 123 Performed Procedures list Images Description Comments Date Time Performing Physician Quality Assurance Number of images in a series or volume dataset on the study level no image number is shown Study or series description Study comment from the DICOM images Date and time when the study or series was performed in the format YYYY MMM DD and HH MM SS 24 hour clock Performing Physician entered for this study or series Menu and Icons of the Performed Procedures list Move Split de Move to New Patient Merge Patients 2 124 These commands can be found in the Edit menu of the menu bar as well as in the context menu The items of the Edit menu can also be displayed as an own menu bar The functions can also be called up via icons in the toolbar Moves one or more images series or studies to other existing series studies or patients At least two items must be selected Items can only be moved to items on a higher hierarchical level
121. opy your results table onto the Export tab card from where you can insert in into your report If you want to continue evaluating your results with another program e g Excel you can export them as a comma separated list with the Export CSV button With Reset you can delete any assignments you have so far made and start again Batching tools Batching is a process in which special reformatting creates new image series The Batching tool is used to review change the parameters of reformatting in a slice viewer or VRT before reformatting is started In addition the properties associated with the batching workflow can be viewed and adapted if required Batching tool card 104 You can start batching on this tool card In this process regular linear or rotational stacks of images within a given dataset are defined Three different methods of batching with different parameters are available e Stacked Batching e Horizontal Rotational Batching e Vertical Rotational Batching Stacked Batching Allows to review change the parameters of stacked batching The parameters Number of Images Image Thickness Overlap and Distance are available Clicking on the lock symbol before either Number of Images Image Thickness or Over lap allows you to change this parameter by means of dragging the mouse within the viewer Other parameters may be adapted automatically to keep the data consistent Visage 7 Client View Window Batching tool
122. or in italics or underline them e Change the color of selected text e Re align text left center right or justified e Apply predefined paragraph styles 116 Visage 7 Client Report text Export Window Edit Actions Report text Inserting snapshots Placeholders Visage 7 Client e Select a different type font or font size for selected text With the icons of the Edit Actions toolbar or the commands of the Edit menu you can e Undo the last editing action or redo the last action you undid e Cut or copy selected text to the clipboard or paste text from the clipboard e Search for text or search and replace text In the report text section of your report editor you can type text insert snapshot im ages or insert placeholders for patient and study information Select one or several snapshots in the Snapshot section of the Export window and drag them into the report text section to include these images in your report Use the Edit gt Insert Placeholder gt menu to select and insert a placeholder into your report text Placeholders are populated with patient and study information as soon as you insert snapshots into your report Placeholders are particularly useful when you create report templates Diagnostic Report Patient Name lt PATIENTMAME gt Study Date lt STUDYDATE gt Patient Gender lt SENDER gt Study ID lt STUDYID gt Referring Physician lt MDREFERRING gt Tip If yo
123. or patient entries after you confirm a safety query Check Delete from Archive in the safety query if required Assign Order to Assigns a study selected in the Performed Procedures list to an order selected in the Study Scheduled Procedures list You are prompted to confirm the assignment Visage 7 Client 125 Scheduled Procedures list Quality Assurance Scheduled Procedures list The Scheduled Procedures list contains the scheduled procedure steps sent by the RIS Some of them may have to be manually matched to studies Information in the Scheduled Procedures list The individual columns contain information on patient visit and order level provided by the RIS with the exception of the Assigned column where you can see whether an order has been assigned to a study or not Menu of the Scheduled Procedures list The only command available for the Scheduled Procedures list can be found on the menu bar as well as in the context menu Assign Order to Assigns a study selected in the Performed Procedures list to an order selected in the Study Scheduled Procedures list You are only prompted to confirm the assignment 126 Visage 7 Client Visage 7 Client configuration Users can adapt program functions and the appearance of the Visage 7 Client user interface to a certain degree Some of these configuration options are available to all users while others can only be accessed by users with appropriate user rights Users with the right to acc
124. or reconstructed images in MPR viewer segments is specified in the active protocol It is usually the slice thickness of the original scans You can change the slice thickness for your loaded images and subsequently choose a different compositing technique for thick slices e Thin MPR In this mode slices are shown in their original native thickness e Maximum intensity MIP Data values are computed as the maximum of the values of the original slices e Minimum intensity MinlP Data values are computed as the minimum of the values of the original slices e Average intensity AvIP When displaying a thick slice data values are computed as the average of the values of the original slices You work with the Viewer controls or the Display tool card when changing the slice thickness and selecting a different compositing technique Or Use the keyboard shortcut T to turn thick slice display on and off MPR viewer context menu The MPR viewer context menu provides quick access to functions Some of these functions are also available from toolbars or tool cards while others can be selected in this context menu only Right click in a viewer segment to show the context menu Or Use this control in the viewer control bar to call the context menu Visage 7 Client View Window MPR viewer context menu options Fullscreen Viewer Controls View Study Re ports Select As Base line Phase Store Key View Recall Key
125. playback Select Loop to play the film in an endless loop 85 Tool cards Cine tool card for the 3D viewer image stack or time series Batching Parameters Axis Position Best 3D Quality Update All View ers gt UU 86 View Window Click the Record icon to open the Cine Options dialog box Here you can choose whether you want to save your film as an MPEG movie on your local computer or as separate snapshot images like in a slide show or as anew DICOM series on your local computer or on a connected DICOM server cine Batching Batching Rotation Time Rotation Parameters Position Start Angle Increment End Update All Viewers Most Vertical Object Coordinates Screen Coordinates Best 3D Quality DE Select an animation mode here Rotate this rotates the entire volume Crop this has a crop plane move through the volume only shown if the Crop Plane tool is currently turned on Time this plays the volume back over the time axis only shown if the loaded dataset is a time series Select the rotation Angle 360 is full rotation and Increment Select a rotation axis and decide whether this axis refers to the patient coordinate system Object Coordinates or to Window Coordinates Select a Start position and End position slice for your movie Check this box for slow playback or recording in best 3D quality Only active for time series Wi
126. r 29 Default Navigation Ctrl key 58 Default Navigation icon 58 Define Artery icon 71 Define Contour in 3D icon 95 Define ROI icon 72 Define Vein icon 71 Index Define Edit Curve 70 Define Edit Curve icon 70 71 Delete button 34 Delete Key View 45 49 Deleting data Database 34 Density profile 88 DICOM dcm 85 DICOM Annotations 50 DICOM Job List 110 DICOM node 28 retrieving data 34 DICOM Overlays 50 DICOM Print 50 DICOM Shutters 50 Display tool card 79 Display protocol 38 Display tMIP icon 71 Distance icon 61 Distance Ratio icon 62 Drop down icon bars 57 DX digital radiography 29 Dynamic protocols 39 E Edit tool card 94 Edit Annotation dialog box 64 Edit Curve tools 70 Edit Viewer Linking icon 69 Editing annotations 64 Elliptic ROI icon 63 Email Session Link 110 Encircle Voxels in Value Range 2D icon 95 Encircle Voxels in Value Range 3D icon 95 Export window 113 Export CSV button 99 104 F Feet icon 59 Fields database filter 29 Filter criteria QA 121 Filter criteria Study Browser 29 Fit Height icon 60 Visage 7 Client Index Visage 7 Client Fit View tools 59 Fit Width icon 60 Fit Width Height icon 60 Fixed Position in Viewer 64 Flip Horizontally icon 60 Flip Vertically icon 60 Freehand Crop icon 67 Fullscreen
127. r tiled display mode turning the mouse wheel will scroll one page up or down i e replace all displayed images Study Navigator Click this icon to open the Prior Studies dialog box with a list of any previous studies stored on the Visage server for this patient Study Information Click this icon to open a dialog box with patient and study information You can edit the study comment text here but no other study information 19 Tool cards View Window Tool cards Tool cards may be arranged in one or several stacks usually on the right hand side of the window Alternatively tool cards can be displayed as floating windows Your currently active protocol defines how and how many of the available tool cards are shown right after you have loaded data onto the View window Showing a tool card Click a tab in a stack of tool cards to call this card to the foreground Or Select the tool card from the main menu Tools The tool card will either be added to one of the stacks or be shown as a floating win dow ay 3D Colormap Structures Cine 4 Primary Dataset Overlay Dataset Gray Ramp Call Tip If you do not find the tool card you are looking for in the Tools menu then this tool card is deactivated in your current protocol Select a different protocol in this case Tips for arranging tool cards In order to show a tool card as a floating window double click its tab in one of the tool card stacks In order
128. re existing labels in the list box you can filter this list by means of show public and or show private OR Create a new label by entering a name activating Create Private or Create Public to assign it to your own account or all users The selected label s or new label will be shown in a list You can select an entry in this list and use the context menu to perform the following actions e make a private label public or vice versa e delete a label e assign it to a button on the View window See also Labels tools Protects studies from being deleted from the local database after a certain amount of time or when the database runs full and old studies would automatically be moved to remote Al so protects studies from being deleted manually during Quality Assurance activities You can remove the delete protection later Sends one or more selected studies to network nodes A dialog to select these nodes is opened On the DICOM Send tab you can perform the following actions e define these nodes as default addresses for DICOM Send via Make Default e apply you selection to DICOM Quick Send via Copy to Quick Send On the DICOM Quick Send tab you can perform the following actions e copy the presets to DICOM Send e define these nodes as default addresses for DICOM Quick Send via Make Default Quick Send Sends one or more selected studies to one or more preselected network nodes No confir mation is shown Sends one or more s
129. rently applied to the 3D volume in your active 3D viewer segment A dialog box opens Enter a template name here and decide whether the new template will be available for all users or for your user account only To remove this template from the list select a template thumbnail and click the Delete icon Display tool card On the Display tool card you can adapt display settings for the images in the MPR viewers and the 3D volume in the 3D viewer The Display tool card offers slightly different controls depending on the currently selected viewer segment MPR viewer 3D viewer or 2D viewer and whether fusion mode is currently active or not If you have loaded multiple series or studies you can display the images of these series overlaid 19 Tool cards View Window Click the Primary Dataset checkbox and the Overlay Dataset checkbox on the Display tool card and select datasets from the corresponding dropdown lists Fusion display is particularly suitable for studies from combined multi modality scanners such as CT PET and CT SPECT but you can also use this feature to overlay two CT series for example Uncheck either the Primary Dataset checkbox or the Overlay Dataset checkbox to turn fusion display off again Display card in fusion mode all Display viewers al Primary Dataset CT Qiphase 1 153 CT Spiral 5 0 540s Overlay Dataset PT BOB 299 PET WB CC PT 606 Primary Dataset With this checkbox you turn disp
130. rocedures list whereas the Order tab produces results in the Scheduled Procedures list Allows you to search for a patient s name and ID Allows you to search for patient and study data based on a date or date range You can tog gle the date search on and off by means of the checkbox Type select whether you want to search by e Study Date Date of Birth or Insertion Date i e the date when the data was transferred to the server on the Study tab OR e Date of Birth or Modification Date i e the date when the order was modified on the Order tab From date To date specifies the search period Click in a date box with the cursor and en ter a date in the format YYYY MMM DD e g 2006 MAY 23 Or click the icon button to the right of the date entry box to open a calendar and select a start and end date from here Click one of these buttons to select a default search period Today selects the current day as search period Yesterday selects the previous day as search period 1 Week selects the last seven days as search period 2 Weeks selects the last 14 days as search period Allows you to search for patient and study data by modality You can toggle the modality search on and off by means of the checkbox Choose one of the following options 1 Check the boxes of all those modalities whose studies you are looking for CT comput ed tomography DS digital subtraction angiography DX digital radiography MR mag
131. rofile cannot be shown for distance lines that you have moved as described here Double click an annotation text to open the Edit Annotation dialog box Here you can overwrite the Annotation text change the Font Settings for the an notation text and select a color Set Color and Line Width for your annotation Selecting Move Text Freely allows you to move an annotation text independently of the annotation or measurement graphics With appropriate user privileges you can save your settings for future measure ments and annotations in your user profile or on a system wide basis Click the De fault button in the Edit Annotation dialog box to do so 1 Click the annotation text you want to freeze into this viewer segment for the cur rent dataset 2 Right click and select Fixed Position in Viewer from the context menu When you now start scrolling slices or change the orientation the annotation text will be shown in each slice image and at the same window position Visage 7 Client View Window Toolbars Note Only text annotations can be frozen into a viewer segment this way Arrow annotations and measurement graphics cannot be converted this way Saving annotations Annotations and measurement graphics can be saved temporarily or permanently and measurements l Key view Annotations and measurement graphics are automatically saved as key views This means that when you scroll back to a slice during the same session your annota
132. roperties dialog can be reviewed and changed Select the receiving DICOM node under Destination Under Scout Images select the scout images you want to include as well as Show Mea surements and Annotations and Show Orientation Cube if required You can change the Series Number and Series Description or accept the defaults Click Make Default to save your settings and click Send to send the stack to the selected DICOM nodes Opens the Export dialog Depending on your selection in the Properties dialog the title bar of the dialog shows whether the stack will be exported as Grayscale or RGB Select the file format under Export as For a Grayscale export only DICOM Files dcm can be selected For an RGB export Image File JPG or PNG or Movie MPG can be se lected as well You can enter the path for the export file under Destination and a file name or accept the given one You can also Browse for a destination The file type is automatically appended The following Options are additionally available e You can change Series Number and Series Description for DICOM files e You can select Burn in Patient Information and or Burn in Orientation Letters for im age files e You can select Burn in Patient Information and or Burn in Orientation Letters and additionally change the Frame Rate for movie files Click Export to start batching and the export A message is shown once it is finished The batching toolbar is identical for t
133. ry e check Auto Query to automatically start a query when the preset button is clicked Default e check Default to make this preset the user s default when initially opening the Study M save Cancel Browser window 30 Visage 7 Client Study Browser Study series list Context menu of the preset buttons Properties Default Update Preset with Current Set tings Delete Preset Clicking a preset button with the right mouse button opens this context menu Allows you to change the preset s name and to have the preset perform an Auto Query or set it as Default Checking this menu option defines this preset as default loading its parameters when the Quality Assurance view is opened Updates the preset with the settings currently active in Quality Assurance Deletes the preset button after a query is confirmed Study series list The study series list has tab cards for the local backend server of the Visage system and for each connected DICOM network node or external medium Click a tab to show the study series list of the corresponding database or medium After switching over to another tab card the study series list of the last database query you performed on this tab card is shown Information in the study series list Patient Patient ID Accession Num ber Modality Visage 7 Client The study series list is arranged in a hierarchical tree view Use the icons in front of the entries to expand or
134. s Properties Clicking this button opens the Properties dialog for stacked batching The Value column will show possible changes you have already performed on the tool card In the Modified column a checked box shows that a value was changed and in the De fined in column the value will be set from factory default to user profile You can click Save in user profile to save the changed parameters or reset to the factory defaults by clicking Reset user profile Save Send Initiates batching and a DICOM Send action A dialog is opened where several properties as in the Properties dialog can be reviewed and changed Select the receiving DICOM node under Destination Under Scout Images select the scout images you want to include as well as Show Mea surements and Annotations and Show Orientation Cube if required You can change the Series Number and Series Description or accept the defaults Click Make Default to save your settings and click Send to send the stack to the selected DICOM nodes Export Opens the Export dialog Depending on your selection in the Properties dialog the title bar of the dialog shows whether the stack will be exported as Grayscale reformatting or RGB Secondary capture Select the file format under Export as For a Grayscale export only DICOM Files dcm can be selected For an RGB export Image File JPG or PNG or Movie MPG can be se lected as well You can enter the path for the export file
135. s Each time a user starts a Visage 7 Client session protocols are read into the main memory of the client computer If protocols are modified on the server while a client session is still ongoing this cli ent needs to reload protocols in order to be up to date Use the File gt Reload Protocol command to synchronize your protocols with those on the Visage server 136 Visage 7 Client Index Visage 7 Client 2D ROls 63 2D viewer 51 layout 51 3D Color Map tool card 81 3D MinIP inverse 42 3D MIP 42 3D projection modes 43 3D rendering techniques 42 3D Rotate icon 58 3D templates 78 user defined 78 3D viewer context menu 45 3D viewer segment 41 A Accept Registration icon 69 Access control 10 Align Centers icon 69 Alignment datasets 68 American Heart Association AHA 101 Angle icon 62 Angle BetweenDisconnected Lines icon 62 Annotation arrow 61 circle 61 text 61 Annotation and Measurement tools 60 Anterior icon 59 Arrow Text Annotation icon 61 Audit trails 11 Authentication 10 Auto logoff 11 Auto logoff session 35 Automatically Link Viewers icon 69 Average intensity AvIP 48 AvIP average intensity 48 B Batching tool 104 Batching tool card 104 Horizontal Rotational Batching 105 Stacked Batching 104 Vertical Rotational Batching 106 Batching toolbar 107 Bilinear Filtering 50 Bone tool card 92 Bones
136. s active in a viewer segment a histogram of grayscale values is also shown in the lower left hand corner of the segment A small white bar that moves as you shift the window center and expands or shrinks when you change the window width in dicates the current window settings graphically Note that when you window an image segment in fusion mode this will affect the window values of the primary dataset In order to window the image of the overlay dataset hold the Shift key pressed while you window the image Browse Slices F6 The browsing tool allows the use of the mouse to navigate through an image stack in an MPR viewer Select this icon click a viewer segment hold the mouse button pressed and drag the mouse cursor up down to scroll forward or backward through the image stack Position Crosshair F7 Select this icon and click a visible opaque structure in the 3D viewer or any point in one of the images in the MPR viewer segments This sets the crosshair cursor of the MPR viewers to this 3D position and updates all MPR viewer segments that show this dataset Orientation tools Anterior A Posterior P Left L Right R Head H Foot View F Displays the volume in the 3D overview segment or a slice image in one of the MPR viewer segmenis in the standard anatomical views anterior posterior left right head or feet Image size tools Zoom 100 Clicking this icon represents every pixel in the image as a pixel on the
137. s of the currently active tool Position Crosshair F7 moves the crosshair center in all viewer segments to this point This updates all MPR viewer segments that show this dataset Position Crosshair F7 see above Changes the slice thickness when you perform this action in an MPR viewer segment Or Selects the Crop Slab tool and changes the slab thickness if you perform this action in the 3D viewer segment Generally mouse operation for Mac users is the same as described above with the Ctrl key replaced by the Cmd key However in order to use these functions you should apapt the mouse settings to distinguish left and right mouse button via Sys tem Preferences gt Mouse Note Some types of mice such as the Mighty Mouse and Magic Mouse from Apple do not support pressing the left and right mouse button together In this case window levels have to be changed by activating the W L Tool 55 Toolbars View Window Toolbars A number of icons are shown along the edges of your window after you have loaded data With these icons you can start functions or select options with a single mouse click The icons are grouped in toolbars Which toolbars are shown when you first load data as well as the toolbar position depends on the currently active protocol If you wish you can change the arrangement of toolbars for the duration of your cur rent session You can show more toolbars or hide toolbars currently shown or you
138. s quick access to functions Some of these functions are also available from toolbars or tool cards while others can be selected in this context menu only Tip Refer to the Toolbars section for an explanation of all context menu entries with a small icon or image in front of them Right click in a viewer segment to show the context menu Or Use this control in the viewer control bar to call the context menu Visage 7 Client 43 Viewer segments View Window Fullscreen Viewer Contral View Study Reports Primary Study 2006 Jan 26 CT SNCT132CTA BRAIN Via 3D Volumes 1 Overlay Study none store Key view Bounding Box Centerline View Orientation Properties Attach Detach Wiewer we Link Viewer Navigation 44 Visage 7 Client View Window 3D viewer context menu options Fullscreen Viewer Control View Study Re ports Store Key View Recall Key View Delete Key View Crosshair Bounding Box Centerline View Orientation Properties Attach Detach Viewer Visage 7 Client Viewer segments Select this menu option or double click in the 3D viewer segment to display the 3D viewer in full screen mode Select the command or double click again to return to the previous screen layout Check or uncheck this commands to show or hide the viewer controls bar below the 3D viewer segment If a study report has been sent to the Visage from the RIS you can show this report in a separate window
139. se the Export window to create reports which include selected snapshots and report text Or you use the Export window to save snapshot images in the Visage database to send them over the network or to export them onto your lo cal computer e Quality Assurance Wally Assurance You use the Quality Assurance window to correct or re assign patient study and series data manually and to match studies with orders sent by a RIS system The general Visage 7 Client window layout Visage 7 Client features an intuitive user interface which is easy to learn and allows you to perform image manipulations with a minimum of clicks The Visage 7 Client window comprises the following basic window areas Menu bar Visage Client windows Workspace of the Visage 7 Client windows 24 Visage 7 Client Getting Started The general Visage 7 Client window layout Visage 7 Client windows Workspace of the Visage 7 Client windows Visage 7 Client The Visage 7 Client comprises four windows You move from one window to the next by selecting the respective entries in the Window menu or by clicking the cor responding button Windows only Study Browser mew Export Quality Assurance Note Switching between windows does not load data The new window shows the data that you queried for or loaded the last time you worked on this window For a detailed description of the operating elements of the four program windows please ref
140. section allows you to search a database for studies performed on one or several modalities E g check CT MR and DX modalities in the query section to show all studies and series that were performed either at the CT or the MR or the DX modality All other entry boxes in the query section are filter criteria This means the more cri teria you define the shorter the hit list will be E g enter A for patient name to show all patients whose name starts with an A Or enter A for patient name and select to day for study date to show only those patients whose name starts with an A and who were examined today If you do not remember a name or number you are looking for you can use wild cards in your search E g type Mil in the patient name box to find Miller Milford Miltner or mil to find all the above and also Hamilton or AB 34 in the patient ID box to find AB1234 AB0034 and AB11345678 Visage 7 Client Study Browser Query section Even if you use wildcards you should always specify your search criteria as pre cisely as possible Rather general queries may yield a very long hit list which would require extensive scrolling Filter and search criteria Patient Date Modality Visage 7 Client Fields Allows you to search for a patient s name and ID Allows you to search for patient and study data based on a date or date range You can tog gle the date search on and off by means of the checkbox If toggled on
141. segment Starts a DICOM print action either for the current image or image set You can select the DICOM printer you want to use as well as layout and media properties Opens a submenu with commands for rotating flipping and centering images Opens a submenu with alternative display options for the selected viewer segment Use this submenu to toggle between thin or thick slice display and to switch between com positing modes for thick slices see also Compositing modes for thick slices Also use this submenu to select Bilinear Filtering which interpolates MPR rendered slices for a smoother appearance or to show or hide Slice Boundaries Opens a submenu in which you can detach which means temporarily remove a viewer from a linked viewers group Or Select Edit Viewer Linking in this submenu to enter viewer group editing more In this mode icons that represent groups of image manipulation tools are shown in the various viewer segments You add a segment to a group by selecting the corresponding tool icon in a viewer segment End this more by confirming your selection checkmark icon in the lower right hand corner of the last viewer segment in which you have clicked a tool group icon If several series are loaded which show the same anatomical region same frame of refer ence but from a different orientation you can show the location of images of one series in the images of the other series as scoutlines Visage 7 Client View
142. session These menus and commands are available on all Visage 7 Client windows About VisageCS Opens a message box with information about the currently installed pro gram version the accessed servers and information about the current program session Quit VisageCS Closes the Visage 7 Client Online Help Shows the Visage 7 Client online help system Audit Warning Displays a dialog box which informs users that their activities may be mon itored This command is shown only if the audit trail license has been installed on the server Keyboard shortcuts Shows the list of keyboard shortcuts for Visage 7 Client Visage 7 Client study Browser Study Browser Basic workflow Local backend server or partner system Remote DICOM node DICOM Server External drive Visage 7 Client The Study Browser is used to search for data on the local Visage server selected when logging in or partner systems bold tabs on a connected DICOM network node tabs in regular typeface or on external drives When searching and loading data you proceed in this order 1 Query the local backend server or partner system 2 Select one or more study or series 3 Load this data onto the View window Or Click Add to View to add the data to an ongoing Visage 7 Client session Or 1 Query aremote DICOM node 2 Select and transfer the data to the Visage database Retrieve button 3 Query the local database for example by ins
143. ss service is granted unlimited access Under cer tain circumstances this may include patient data which has not been anonymized Logging of user actions in Visage 7 Client occurs in so called audit trails Audit trails are recordings of access controlled actions They are the proof that access to pa tient data is monitored A message informs users that their actions may be monitored The following activities are recorded if the audit trail option has been activated by the system administrator e Changes to access rights with accessing user date and time e Viewing exporting printing or deleting patient data e Changes to archived images with time date and user e Login and logout and failed attempts to log in e Every query retrieval e Service sessions local or remote 11 Overview of the product documentation System Overview e Software updates as well as backup and restore In addition the highest original number of images is recorded to compare with the current number of images If audit trails must be kept for a number of years it is the responsibility of the system administrator to ensure that the relevant log files are archived according to the re quirements that apply to your institution and country The system administrator is the only user who has access to the audit trails via a dedicated viewer For larger systems a separate database server can be made available for audit trails Overview of the pro
144. t To ey enter a name for the preset auto query e check auto query to automatically start a query when the preset button is clicked Default Save Cancel e check Default to define this preset as default for your user account loading its param eters when the Quality Assurance view is opened 122 Visage 7 Client Quality Assurance Performed Procedures list Context menu of the preset buttons Properties Default Update preset with current settings Delete preset Clicking a preset button with the right mouse button opens this context menu Allows you to change the preset s name and to have the preset perform an auto query or set it as Default Checking this menu option defines this preset as default loading its parameters when the Quality Assurance view is opened Updates the preset with the settings currently active in Quality Assurance Deletes the preset button after a query is confirmed Performed Procedures list The initial contents of the Performed Procedures List depend on your default query preset Typically the studies with QA status SCHEDULED will be shown since these are most likely to be in need of manual correction Information in the Performed Procedures list Patient Name Patient ID Birth Date Sex QA Status Accession Number Study ID Modality Body part Visage 7 Client The Performed Procedures list is arranged in a hierarchical tree view Use the ic
145. t to be displayed Shows the histogram of the primary dataset Use the slider right below the histogram to adjust the window settings for this dataset Or Drop down a list of available color maps with the arrow button to the right of the histogram and select a suitable color map Always Highest Resolution check this box to show full resolution images even during im age manipulation this may slow down program performance Or uncheck this box to show a downsampled slice image during program interaction e g for thick slices or during rota tion Use the Quality slider to decrease or increase image quality during program interaction moving the slider to the right will increase image quality but may slow down system perfor mance 3D Color Map tool card 3D viewer The 3D Color Map tool card allows you to select and edit the color map that is used for VRT rendering in the 3D viewer segment A color map assigns colors and transparencies to different tissue types as defined by their window values By selecting and adjusting a color map you focus on structures and tissue types that are of particular interest to you With a suitable color map you can display these structures particularly clearly and hide structures and tissue types which would only distract you from the question at hand A number of predefined color maps came with your system Advanced users may choose to adjust these to their own requirements or define their own set
146. t to show in the 2D viewer segments Visage 7 Client 51 Viewer segments View Window 1 Tile 2 Tiles 3 Tiles 2x2 Tiles axe Tiles 4x2 Tiles Current Prior 1 Current Prior 2 If the Layouts toolbar is not currently shown select it from the context menu of the toolbar section or from the View gt Show Toolbars submenu Interactive arrangement of viewer segments and image data When you load image data onto the View window a protocol is automatically select ed This protocol defines the arrangement of viewer segments and which images or volume data are shown in these segments In order to adapt the arrangement of image data interactively you use the Layout toolbar and the Image Series tool card Layout toolbar If the Layouts toolbar is not currently shown select it from the context menu of the toolbar section or from the View gt Show Toolbars submenu MPR VRT 4eMPR Large Axial CPR Residual Series The Layouts toolbar offers you alternative arrangements of viewer segments which have been defined for the currently active protocol Click on of the buttons in this toolbar to show a new arrangement of viewer seg ments on the View window Image Series tool card The Image Series tool card is usually shown along the bottom of the window It con tains thumbnails of all the currently loaded studies series images and volume datasets It can be opened using the arrow button if it is not opened automatically Cur Loc 1 C
147. ted in mm square millime ters Refer to Editing annotations for information on how to move or edit measurement graphics The relative error of the elliptical ROI measurement is 2 pixels shorter radius For example Shorter radius measurement error 10 pixels 20 20 pixels 10 50 pixels 4 100 pixels 2 Larger errors can occur if the image is displayed with reduced matrix size that is if not every original pixel is shown on the screen due to zoom out For optimum ac Curacy we recommend zooming into the structure of interest as much as possible The accuracy is further limited by the physical resolution of the acquisition itself If the monitor used for display does not permit exact pixel selection the inaccuracy can be greater still Circular ROI Click this icon and draw a circular ROI The ROI area is indicated in mm square millime ters Refer to Editing annotations for information on how to move or edit measurement graphics Spherical ROI Click this icon to draw a spherical ROI in a 3D dataset When you release the mouse button Statistics for both the diameter and the volume of the sphere are shown Refer to Editing annotations for information on how to move or edit measurement graphics Point Sized ROI Select this icon and click a point in an image to show the density value as a measurement graphic which you can save in a key view or snapshot Refer to Editing annotations for informat
148. th a high priority ranking also show up at the top the list when users drop down the Pro tocols menu Scroll through the list of all protocols defined for your system in the lower part of the Protocols dialog box or use the Filters in the upper third of the dialog for a better overview Save Protocol wizard Protocol definition workflow 134 With appropriate user privileges you can modify protocols or create protocols of your own Visage 7 Client expects you to base any protocol definitions on an exisiting protocol The workflow for protocol modification therefore comprises the following steps e Loading appropriate image data onto the View window e Selecting the protocol you want to modify from the Protocol menu e Adapting display settings including toolbar and tool card selection e Calling up the Save Protocol wizard e Entering or modifying the protocol name Now you can decide to save your modifications right away or to further review and modify the affected settings By going through the individual pages of the Save Pro tocol dialog box you can control the following protocol related settings e Defining protocol access and matching criteria Visage 7 Client Visage 7 Client configuration Protocol configuration e Defining toolbar and tool card settings or accepting interactively made modifica tions e Defining layout and viewer properties or accepting interactively made modifica tions e Defining image
149. th this checkbox you decide whether you want to apply cine mode to all viewers or wheth er you want to play the film in the selected viewer only Click Play or use the keyboard shortcut C to play your film back once Click Pause or use the keyboard shortcut C to halt the playback Visage 7 Client View Window Cine tool card for lumen viewer or CPR Batching Position and Increment Parameters and Axis Best 3D Quality Update All View ers gt UL Visage 7 Client Tool cards Select Loop to play the film in an endless loop Click the Record icon to open the Cine Options dialog box and save your film as an mpg file Select recording settings here and choose whether to save the movie to your local com puter or to a connected DICOM server Cine Cine Batching Batching Rotation Stack Rotation Position Parameters Start Angle End TRE Increment Increment Same As Slice Distance Custom Best 30 Quality oO Best 3D Quality 101 200 p Select whether you want to scroll slice by slice Stack or whether you want to rotate around the segmented structure or vessel Rotation If you have selected Stack mode Select a Start position and End position slice for your movie Select an Increment for scrolling This can either be the Same as Slice Thickness or any other value Custom If you have selected Rotation Select the rotation Angle 360 is full rotation
150. thogonal to the current image plane This portion is removed from the volume in the 3D viewer segment Freehand cropping mode is also ended In order to work with the full volume dataset again 1 Click the Freehand Crop tool a second time 2 Click Remove Reset on the context toolbar in the lower right hand corner of the active viewer segment 3 Click OK 67 Toolbars 68 View Window Remove Table If the table is shown in your images this tool offers a quick and easy way to remove this arti fact in CT datasets Remove Leg Bones Applies a lower extremities bone removal segmentation to a CT Angio dataset provided you have performed an automatic bone segmentation run during this or a previous session with this dataset Bone segmentation with the Bone tool card is automatically stored by the system If no segmentation information exists for this dataset a message box informs you about this fact Call the Bone tool card from this message box and perform bone segmentation now Remove Chest Wall Click this icon to remove the chest wall ribcage from a CT thorax dataset Fusion Registration tools Visage 7 Client allows display of suitable datasets in so called fusion display Fusion display overlays datasets for example a CT and a PET series of the same study Fusion display requires that datasets are registered which means that they are aligned spatially When you load two datasets suitable for fusion display Visa
151. time to Peak TTP cerebral blood flow CBF cerebral blood volume CBV Define ROI Select the original scan image tMIP image or any of the functional images e g MTT and click Define ROI on the toolbar to activate mirror mode and to define and evaluate regions of interest in this image A vertical line has appeared in the image segment Click and drag the end points so that the line separates the left and right half of the brain Use the tools in the context toolbar in the lower right hand corner of the image segment to define an elliptical ROI or a freehand ROI As soon as you release the mouse button a mir ror image of your ROI is shown in the other half of the brain ROI statistics are shown in all four functional images The Refine Contour tool is active now Correct the contour of the ROI you have drawn do not correct the mirror ROI Click anywhere in the image to show the nudge tool This tool has the shape of a circle The further away you click from the contour the larger the circle will be The closer to the contour line you click the smaller will be When you have clicked outside the contour you can use the nudge tool to push the contour line in and reduce the area defined by the contour When you click inside the contour you can push the contour line out and increase its area Use the Undo icon on the context toolbar to undo contour editing step by step Click OK when you have finished refining contours and adding RO
152. tings 81 139 140 LV Analysis tool card 99 Report button 101 LV Results tool card 99 Bull s Eye View 102 Endocardial Distance 102 Global Volume 102 Regional Volume 102 Summary 102 Wall Motion 102 Mac users change windows 24 Cmd key 55 mouse operation 55 mouse settings 55 quit VisageCS 20 Visage client download 18 Visage client installation 18 Main menu 26 Manual Registration icon 68 Maximum intensity MIP 48 Measurement angles 62 calibration 63 circular ROI 63 Cobb s Angle 64 density 64 distance ratio 62 distances 61 elliptic ROI 63 point sized ROI 63 vertical distances 62 MG mammography 29 Minimum intensity MinIP 48 MinIP minimum intensity projection 48 MIP maximum intensity projection 48 Mirror Mode icon 72 Modality database search 29 Modality search QA 121 Modality search Study Browser 29 Mouse operation 54 Movie 85 MPEG movie 85 MPR viewer Index context menu 49 MPR viewer segment 46 MPR viewers display settings 81 MR magnetic resonance tomography 29 Multiphase tools 72 Multi planar reconstruction MPR 46 Multi session operation 11 My recent sessions 35 Myocardial mass calculation 102 N Navigation tools 58 Navigation crosshair 47 New Session 110 Next Phase of Time Series icon 60 Next Study icon 60 Next Volume or Muliframe
153. tions and measurements will be shown again As soon as you close Visage 7 Client key views are lost unless you save them Tip Use the Recall Key View item in the context menu of each viewer to return to a view in which you performed measurements or added annotations e Session management You can save key views and other display settings in a session Use Save Ses sion or Save Session As from the main menu to do so e Snapshots Use the Snapshot Active Viewer S icon to save your measurements and anno tations in a snapshot You can then insert a snapshot in your report or save it on to your hard disk Visage 7 Client 65 Toolbars 66 ot Hey aE H EE View Window Snapshot and Cine tools Snapshot Active Viewer S Creates a snapshot of the active viewer segment and places it on the Export tab card where it will be available for reporting Snapshot All Viewers Shift S Creates several snapshot images one for each image segment currently shown on the win dow Or Combined Snapshot All Viewers creates one snapshot which contains all image seg ments currently shown on the window Cropping tools Use the cropping tools to cut away portions of the volume which hide more impor tant information that lies underneath When you click a crop tool orange lines appear in the MPR viewer segments These lines define the area to be cut away You can resize the crop region by click ing these orange
154. to lock or unlock objects Locked objects are not affected when you add objects to a selection or remove objects from a selection with the plus or minus but tons Structures tool card The Structures tool card provides tools for easy segmentation and analysis of structures such as tumors in CT or MR datasets In order to segment a structure in your dataset you proceed as follows 1 Decide whether you want to evaluate a 2D structure or a 3D structure and click the corresponding button on the Structures tool card 2 Define its contour 3 Refine this contour if necessary 4 For 3D structures scroll through your slice images and repeat contour definition in slices that show the structure in question Visage 7 Client interpolates the contours and calculates the volume of the struc ture 5 Click Calculate Volume on the structures tool card to have the system calculate the volume of your 3D structure 6 Move on to the Statistics tool card to save the calculated volume and contour ar eas of your structures You can send the data to the Export window from there or export them to your hard disk as a comma separated list file Visage 7 Client View Window Tool cards Structures Structure Mame Vol Ares MPR SD 20 ROI 1 wf 30 ROI 2 a Contour 1 15 4 cm Contour 2 11 2 cr Ca Hew 20 P Mewe 3D g2 Delete Calculate volume Statistics Structure Name Lists all structures you have defined in your dataset and for
155. tool card sce stesnerecchinngan cidade a een dccbens saadtebecicectad tod 103 AUG OOS seacewnes catcher enuticent E tea enh chain eenetocanes 104 BD AlChING TOO Cal O incererstatda isn ar e tery aaa 104 Stacked Batching ccccccccsescecceessececeeeeeeceeeseceeeeeeeesseegeeeeeeeeseesegeeeesseeeeeseas 104 Horizontal Rotaional Bate hingzsneun irana ti Gases nivivadee eeu iGanarls 105 Vertical Rotational Batching cccccccccseeeeeseeeeseeseeceeeeeeseseeesaeeesseneeeseeeeesees 106 BACANI TOODA ii siaie Se ceetvaecu dnc onde netic lelecedienig a etal aeeeeen 107 Additional tools for time series ANALYSIS ccccceeceecseeeeeeeeeeeeeeeaeeeeesaeeeeeesaeeeeeeeas 109 Time density analysis for ROIS cccccecccccsseeseeeseeeeeceeeeeeeeeeeeeeeeeeeeeeeseeeeeesaas 109 SUDMACHONMTON TIME SCM OS aena a bead 109 View WINGOW main MenU sisinrosi aiekin aea E a a a aE Eaa aa 110 Visage 7 Client 3 Table of Contents Export Window 113 Snapo Nols eosa I a Wenaa det aN A N 115 Report editor TOOID AM ronse a a A N 116 PCD OM SMe o a aa E a Ea 117 Quality Assurance 119 Query Se ciO nsin ran a a a 120 Filler rand Searc hCrerd T 121 Starting and resetting a SCALCN cccccccssescecceeseeeceeeeceeeeneeeeeuaeseesseseeeesaneeeeseas 122 FS OTS HO 1 A ENAA ES AEAN EA EEE SE E E A E EE EAA 122 Context menu of the preset DUTtONS ce ececccceeecceceeeeeeeeaeeeeeeeeeseeeeaeeeeessaaaeess 123 Performed Procedures liSt
156. tory import and load the data onto the View window from there Allows you to load individual DICOM files from hard disk CD or from an external drive Return to the Study Browser after DICOM file import and load the data onto the View win dow from there See Visage 7 Client configuration Protocol configuration See Visage 7 Client configuration Protocol configuration Starts a new session Loads a session that you have saved for this dataset Saves changes to your current session Allows you to save your session under a new name Allows you to send a session to a colleague as an attachment to an email Do not forget to save recent changes to your session data before sending the link Shows a list of data retrieval and send jobs that are currently being processed In the DICOM Job List dialog box you can cancel individual jobs or all jobs Allows you to show the DICOM information for the first image of each of the loaded datasets or slice images Opens a submenu with configuration options See Visage 7 Client configuration General preferences View 110 Visage 7 Client View Window Viewer Proper ties Show Tool Cards Show Toolbars Show in Viewer Reset all Warn ings Render Settings Open Reports Viewer Find Prior Stud ies UI Appearance Streaming Com pression Protocol Restored Ses sion Protocol Protocols list Configure Proto cols Tools Visage 7 Client View window mai
157. ts also include the results of LV or calcium scoring analyses sent to the Export window with the Results button on the corresponding tool card All snapshots you create during a Visage 7 Client session are collected in the Snap shot section of the Export window From here you can save them send them over the network or include them in your report 1 Click a snapshot to select it Or Hold the Ctrl key pressed while you click snapshots to select more than one im age 2 Click Delete to remove the selected snapshots from this window section Or Click Save to export images onto your local computer or a network drive and folder in your network Select DICOM JPG or PNG as a file format Use the Send button to save selected snapshot images in your local database or DICOM network A dialog box opens when you click this button Select Local here to save the se lected snapshot images in the database The images will be added to a study as a new series Or Select one of the configured remote DICOM nodes to send the selected images in your DICOM network Note If you select multiple images and save them as DICOM or send them to a DICOM server anew DICOM series will be created assigned to the original study If you select images from multiple different studies one new DICOM series will be created for each of the studies containing only the images belonging to that study Or FA Select Web Client to show the sele
158. u can use the MPR viewer segments to create new slice images by moving and rotating the navigation crosshair You can change the slice thickness and choose a different compositing technique for your images If you have loaded suitable volume data i e two series of volume datasets from the same study you can toggle between the primary and overlay dataset activate fu sion mode and fade between the primary and the overlay dataset filets WI06 Jan 28 NCT132CTA BRAIN WOA AUTOTESTOOS ARN an 09 23 26 MPR Batch Cine2 3D 1 sagittal ae 257 512 A als ra Chi CONTRAST Thin MPR 1 0mm 46 Visage 7 Client View Window Visage 7 Client Viewer segments Navigation crosshair For volume datasets the navigation crosshair in an MPR viewer segment indicates the orientation and position of the slices that are currently shown in the two other MPR viewers for this dataset e A blue line represents the image currently shown in the MPR segment with the blue viewer frame e A green line represents the image currently shown in the MPR segment with the green viewer frame e A red line represents the image currently shown in the MPR segment with the red viewer frame Small arrows pointing to the crosshair indicate the viewing direction in the other two MPR viewer segments When you move the cursor over the center of the crosshair the cursor changes shape Click and drag the entire crosshair This moves two vie
159. u try to combine snapshots from several studies in one report a message will prompt you to confirm this The message will also remind you to check study spe cific information and ensure that placeholders have been populated correctly 117 Report text Export Window 118 Visage 7 Client Quality Assurance Gualty Assurance Overview of the user interface Visage 7 Client You can use Quality Assurance QA to manually fix incorrect patient study and series data to re assign images to the correct patient study or series to merge pa tients or delete patient entries and to match studies with orders sent by a RIS sys tem By default all studies will be shown Performed Procedures list Filter for studies with QA status SCHEDULED indicating that automatic data consolidation did not produce satisfactory results to view studies which need to be QA processed Orders from the RIS can be displayed in the Scheduled Procedures list Dedicated QA user rights are required to perform QA activities Quality Assurance window menu Presets bar Query Performed Procedures list studies section 119 Query section Quality Assurance Query section Study Order Modality search Filter criteria Wildcard search 120 Queries can be applied either to the studies list performed procedures or to the or ders list scheduled procedures with slightly different filter criteria The query section allows you to se
160. u want the system to segment and remove pelvis and spine or the bones of the legs or both If you have selected pelvis and spine segmentation the system expects you to locate the aorta Either scroll to a slice that shows the aorta clearly and place the navigation cross hair over the aorta Or click this button to have the system find the aorta Click Compute to start the segmentation run Use these buttons to toggle between hiding the bones in the 3D viewer showing only bones and showing the complete volume again Click the Reset button if you are not satisfied with the results of bone removal Select Load Pre Computed Segmentation and click Load to redisplay the results of a segmentation run you performed earlier or during a previous session Selecting Load Pre Computed Segmentation and clicking Load has the same effect as clicking the Bone Removal icon on the Remove tools 93 Tool cards Basic workflow 94 View Window Edit tool card The Edit tool card allows you to segment structures or to refine segmentation re sults created by semi automatic Visage 7 Client segmentation tools such as the bone removal tool In order to segment a structure in your volume dataset proceed as follows 1 Select Create New Object in the context menu of the objects list in the lower half of the Edit tool card 2 Point the mouse to the generic object name select Rename Object from the context menu and enter a descriptive object
161. under Destination and a file name or accept the given one You can also Browse for a destination The file type is automatically appended The following Options are additionally available e You can change the Series Number and Series Description for DICOM files e You can select Burn in Patient Information and or Burn in Orientation Letters for im age files e You can select Burn in Patient Information and or Burn in Orientation Letters and additionally change the Frame Rate for movie files Click Export to start batching and the export A message is shown once it is finished Horizontal Rotational Batching Number of Images Increment Image Thickness Overlap and Direction buttons for 5 Allows to review change the parameters of horizontal rotational batching The parameters clockwise and anti clockwise rotation are available Clicking on the lock symbol before either Number of Images Increment allows to change this parameter by means of dragging the mouse within the viewer Other parameters may be adapted automatically to keep the data consistent Visage 7 Client 105 Batching tools View Window Properties Clicking this button opens the Properties dialog for horizontal rotational batching The Value column will show possible changes you have already performed on the tool card In the Modified column a checked box shows that a value was changed and in the De fined in column the value will be set from factory default to
162. urrent 1 Current 2 Current 3 sip pm is ii pee a i F p J pi IF te a E PROT E 4 j ih y iets cT e Sr Si ae ee 1 vol 1 vo SERIES 2 phases T 4img 52 Visage 7 Client View Window Loading image data Folder icon CT 10426 oe m N D O G 1 Oe Q Protocol or series mode PROT SERIES Visage 7 Client Viewer segments Use the thumbnails to load volume datasets 2D images or image stacks into the various viewer segments Click a thumbnail and drag it onto a viewer segment to replace the images in this and any other viewer segments that shows orthogonal slices or the 3D display of this dataset Or Right drag the image into a viewer segment in fusion mode in order to define this dataset as the overlay dataset Use the viewer context menu to undo this setting lf a thumbnail represents several volume datasets images in a series or phase im ages this is indicated by a small folder icon in the lower right hand corner of the thumbnail Double click the thumbnail with the folder icon to show the volume datasets or imag es it contains Use the Go back icon green arrow to return to the dataset overview display Use these two buttons to toggle the display mode of the Image Series tool card e PROT shows all image series in the current protocol e SERIES shows all loaded series of all loaded studies according to their DICOM hierarchy 53 Mouse operation Vi
163. viewer segment you can rotate this image in order to generate arbitrary 3D views and you can zoom or pan the image and adjust window level Use the viewer controls the mouse the 3D viewer context menu or toolbar icons to do so Tip 3D Rotate is the preselected standard navigation tool in the 3D viewer segment 41 Viewer segments AUTOTESTOO1 View Window Sa aaa Ty a ee ae CTS Miller ANOM Kurt p s 1949 Jan 01 56 ge fab ii 2006 Jan 286 WCTIS2CTS BRAIN WOA Bei ay a 09 23 26 MPR Batch Cine 3D 1 Chi CONTRAST 3D rendering techniques in the 3D viewer Choose one of these 3D rendering techniques from the 3D viewer controls or the 3D viewer context menu 42 3D MIP Maximum intensity projection Visage 7 Client calculates the maximum of all the voxel values lying on the virtual viewing ray behind this pixel 3D MIP requires a grayscale color map 3D MIP inverse Similar to MIP but displayed inversely black on white instead of white on black VRT Volume rendering technique also called emission absorption model This tech nique maps data values to colors and transparencies defined in a 3D color map The voxels are interpreted as small diffuse light sources emitting and absorbing light in the direction of the viewer Each voxel is interpreted as a local diffuse light source without additional shading See also 3D Color Map tool card 3D viewer and Templates tool card 3D view er VRT diffuse
164. w planes simultaneously in the vol ume dataset and shows new slice images in both of the other MPR viewer segmenis Note that the move cursor is not available for Partial Crosshair display When you move the cursor over a crosshair line the cursor changes shape Click and drag this line up or down That will take you through the volume dataset along the two other standard axes and update the view in one of the other MPR viewer segments When you move the cursor over the rotation handles small dots the cursor changes shape Click and drag the cursor up or down to rotate the navigation crosshair This updates the views in the two other slice segments and generates slice images with non standard views When you click one of the small triangles on the crosshair lines along the edges of the im age the crosshair lines are shown dotted You can now change the slice thickness in the MPR viewers by dragging the slice thickness handles up or down As soon as you release the mouse button the slice thickness indicator and the selected thick slice compositing mode are updated in the viewer controls Tip Also show the crosshair in the 3D viewer segment while you navigate through your volume with the navigation crosshair in the MPR viewers See 3D viewer context menu for how to enable crosshair display in the 3D viewer segment 47 Viewer segments 48 View Window Compositing modes for thick slices The default slice thickness f
165. wer segment you can scroll through slice images in an image stack play back a time series over time rotate the volume in the 3D viewer segment or move the crop plane through the volume if the Crop Plane tool is currently turned on You can record these animations for presentation purposes for example You can save the resulting captured images as a new DICOM series dcm in the local data base or send them to another DICOM server in order to distribute the results of your work Or you may save the images to the hard disk on your computer as MPEG movie mpg JPEG jpog PNG ong or DICOM dcm Batching Batching Stack Time Position Position Start Start End End irisi sinari Update All Viewers Same As Slice Distance Custom Select whether you want to scroll through the slice images Stack or whether you want to show a time series over the acquired time Time Select a Start position and End position slice for your movie Select an Increment for scrolling This can either be the Same as Slice Thickness or any other value Custom Check this box for slow playback or recording in best 3D quality Only active for time series With this checkbox you decide whether you want to apply cine mode to all viewers or wheth er you want to play the film in the selected viewer only Click Play or use the keyboard shortcut C to play your film back once Click Pause or use the keyboard shortcut C to halt the
166. window thus repre senting the image as is 59 Toolbars 60 View Window Fit Width Height Fit Width Fit Height Select one of these icons while a 3D viewer segment is active to resize the displayed 3D volume so that it fits optimally in the segment Fit Width Height or so that it makes opti mum use of the segment width Fit Width or segment height Fit Height Or Select one of these icons while an MPR viewer segment is active to resize the images in this and all other linked MPR segments in one go Rotate Flip Images tools Rotate Clockwise Rotate Counterclockwise Select one of these icons while an MPR viewer is active to rotate the image in the active viewer segment by 90 clockwise or counterclockwise Rotation is applied only to the seg ment in which you clicked 3D viewer or MPR viewer Flip Horizontally Flip Vertically Select one of these icons while an MPR viewer is active to rotate the currently displayed im age around its vertical or horizontal axis Note that you cannot flip the 3D volume in the 3D viewer Dataset Navigation tools Previous Study Next Study If you have loaded more than one 3D study use these icons to scroll through the loaded studies Previous Volume or Muliframe Image Ctrl Next Volume or Muliframe Image Ctrl gt If more than one 3D volume is assigned to an MPR or 3D viewer or more than one multi frame image is assigned to a 2D viewer use these tools
167. wn with a differ ent window layout than an MR series or a combination of a CT and a PET series Other study or series criteria may include the study description or part of the body that was examined or whether current and prior studies are being loaded onto the View window e Protocol access and protocol ranking Protocols may have been defined in such a way that they are available for indi vidual users or user levels only Moreover protocols can be assigned priority rat ings by users A protocol with a high priority rating is more likely to be automatically selected than a protocol with a low priority rating A number of protocols have been predefined for your system Users with advanced user privileges can adapt these protocols and their matching criteria or create proto cols of their own see Visage 7 Client configuration Protocol configuration A protocol typically defines the following layout aspects e The number of image segments viewers The initial rendering parameters for each viewer The linking of viewer segments for synchronized navigation in multiple viewers e The availability and location of toolbars e The availability and location of tool cards Each protocol defines one or more so called layouts so you can switch between dif ferent representations of the currently loaded data see also Layouts toolbar If the desired representation does not exist in the current protocol you can select and ap ply a differ

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