iSite 3.5: Hanging Protocols I

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iSite 3.5 Hanging Protocols I
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Table of Contents

• Objectives
• Terminology
• Introduction
• Hanging Protocol Hierarchy
• Presentation States
• Hanging Protocol Configuration
• Additional Information

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Learning Objectives
Understand the purpose and configuration of

• Hanging Protocols
• Hanging Protocol Hierarchy
• Presentation States

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Terminology

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

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Terminology

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

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Terminology

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

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Introduction
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Introduction

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

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Introduction

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

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Introduction

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

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Introduction

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

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Hanging Protocol Hierarchy
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Hanging Protocol Hierarchy

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

Hanging Protocol Identifier Keys Level
Modality Type Very Generic
Modality Type Body Part Specific
Hanging Protocol Group Very Specific
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Hanging Protocol Hierarchy

• This configuration level is specified in the
  Hanging Protocol Wizard

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Hanging Protocol Hierarchy

• User and System Default Hanging Protocols are
  identified in the popup menu as default

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Hanging Protocol Hierarchy

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

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Hanging Protocol Hierarchy

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

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Hanging Protocol Hierarchy

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

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Hanging Protocol Hierarchy

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

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Hanging Protocol Hierarchy

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

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Presentation States
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Presentation States

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

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Presentation States Hierarchy

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

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Presentation States

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

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Delete Presentation State
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Hanging Protocol Configuration
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Hanging Protocol Configuration

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

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Create User Hanging Protocol

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

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Create User Hanging Protocol

• Series Matching Rules are created and
  configured by the site PACS System Administrator
• To create Series Matching Rules, the user must be
  assigned to an Access Group with the Security
  Code ISTHPSTD

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Hanging Protocols Configuration

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

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Localizer, Scout Lines and Invert Image

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

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Monitor Control

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

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Matching Series

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

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Monitor Control

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

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Monitor Control

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

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Main Exam Options

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

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Linking Options

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

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Relevant Prior Loading

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

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Relevant Prior Loading

• The Modality and Body Part option loads the
  relevant priors in the Relevant Exam Timeline and
  the Exam Rack based on matching of the same
  Modality and Body Part
• For example Modality CR and Body Part CHEST

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Hanging Protocols Configuration

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

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Additional Information
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F2 Hotkey

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

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F2 Hotkey

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

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F2 Hotkey
Number of monitors Relevant Prior Found? Monitor 1 Monitor 2 Monitor 3 Monitor 4
1 No New Exam General PA gtgt New Exam General LAT N/A N/A N/A
1 Yes New Exam General PA gtgt New Exam General LAT N/A N/A N/A
2 No New Exam General PA gtgt N/A New Exam General LAT gtgt N/A N/A N/A
2 Yes New Exam General PA gtgt New Exam General LAT Prior Exam General PA gtgt Prior Exam General LAT N/A N/A
4 No New Exam General PA gtgt N/A New Exam General LAT gtgt N/A Empty Empty
4 Yes New Exam General PA gtgt N/A New Exam General LAT gtgt N/A Prior Exam General PA gtgt N/A Prior Exam General LAT gtgt N/A
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F2 Hotkey

• Two-Monitor System loading for the Main Exam
  without prior will display red and blue
  rectangles around the first and second rack
  series, unless otherwise specified in the loaded
  Hanging Protocol
• The images will be displayed on both Monitor 1
  and Monitor 2
• In this configuration, F2 key does not have any
  functionality

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F2 Hotkey

• Two-Monitor System with prior the red rectangle
  will represent Monitor 1 the Main Exam will load
  on Monitor 1
• The blue navigation rectangle represents Monitor
  2, on which the prior exam will load
• F2 key toggles between the first series
  displaying for the Main Exam and Prior and the
  second series displaying on the virtual Monitor
  2 for the Main Exam and Prior

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F2 Hotkey
The image on the left represents the display
prior to selecting F2, while the image on the
right displays the series following selection of
the F2 hotkey
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Main Exam Monitor Layout

• Users can configure how the Hanging Protocol
  loads a Two-monitor system or a Four-monitor
  system in the User General Preferences Main Exam
  Monitor Layout control box

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Main Exam Monitor Layout

• 2-Monitor System Main Exam Monitor Layout
• Left Main Exam on left monitor (1), prior on
  right monitor (2) (this is the default selection)
• Right Main Exam on right monitor (2), prior exam
  on left monitor (1)
• Four-Monitor System Main Exam Monitor Layout
• Left Main Exam on left monitor (1), prior on
  right monitor (2) (this is the default selection)
• Middle Main Exam on inside 2 monitors (2,3),
  prior on outside 2 monitors (1, 4)
• Right Main Exam on right monitors (3,4), prior
  on left monitors (1,2)

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Import and Export Hanging Protocols

• In iSite Radiology configured User and System
  Hanging Protocols may be imported and exported
• To accomplish this Import and Export buttons
  are provided in both User and System Hanging
  Protocol Pages

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Import and Export Hanging Protocols

• No more than 10 User or System Hanging Protocols
  can be imported for the same Hanging Protocol
  Identifier Key
• All imported Hanging Protocols will be set as
  Alternate Hanging Protocols

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For assistance, please call customer support at
1-877-328-2808 or 1-877-328-2809
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