Intellispace Pacs DCX Pacs Viewer Um English

Philips Healthcare
IntelliSpace PACS DCX

Viewer User Guide
R3.2
Document number: 4522 170 21321
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IntelliSpace PACS DCX R3.2 Viewer User Guide
Copyright Notice
© Koninklijke Philips N.V. 2013.
All rights are reserved. Reproduction or transmission in whole or in part, in any form or by any means, electronic,
mechanical or otherwise, is prohibited without the prior written consent of the copyright owner.
Compatibility
Equipment described in these instructions for use may not be used in combination with other equipment or
components unless such other equipment or components have been specifically designated as compatible by
Philips Medical Systems.
A list of such equipment and components is available on request from Philips Medical Systems at the address given
below.
Changes and/or additions to the equipment may only be carried out by Philips Medical Systems. Or by third parties
expressly authorized by Philips Medical Systems to do so. Such changes and/or additions must comply with all
applicable laws and regulations under the jurisdiction of the country concerned, and with the best engineering
practices.
Compliance
This Medical Device meets the provisions of the Medical Device Directive 93/42 EEC (93) Class IIa and FDA
Class II.
If you have further questions regarding the applicable national or international standards, please address them to
the company address below.
Manufactured for
Philips Medical Systems
3000 Minuteman Rd.
Andover, MA 01810
USA
www.philips.com/healthcare
healthcare@philips.com
0123
The IntelliSpace PACS DCX (model number CDP 5000) medical device software must be installed on appropriate
IT equipment that complies with relevant international and national laws and standards on EMC (Electro-Magnetic
Compatibility) and Electrical Safety. Such laws and standards define both the permissible electromagnetic emission
levels from equipment and its required immunity to electromagnetic interference from external sources.
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Contents
Contents ........................................................................................................................................................................ 3
Disclaimers .................................................................................................................................................................... 7
1. Product Features ................................................................................................................................................... 9
2. System Requirements ........................................................................................................................................... 9
2.1 Advanced System Requirements ................................................................................................................... 9
2.2 System Requirements for Stations Launching Images from a CD ................................................................ 9
3. Intended Use ......................................................................................................................................................... 9
4. Reference Documents ........................................................................................................................................... 9
5. Abbreviations ....................................................................................................................................................... 10
6. Study Preview Panel............................................................................................................................................ 11
6.1 Collapse / Expand Studies ........................................................................................................................... 11
6.2 Sort Backward .............................................................................................................................................. 12
6.3 Only Icons / Image information .................................................................................................................... 13
7. Auto Hide mode ................................................................................................................................................... 15
7.1 Fix ................................................................................................................................................................. 15
8. Image Selection Display ...................................................................................................................................... 17
8.1 General Image Selection .............................................................................................................................. 17
8.2 Matrix Image Selection ................................................................................................................................. 17
9. Patient Navigation ................................................................................................................................................ 18
9.1 Patient Navigation in the Multi-Site Environment ......................................................................................... 19
10. Study Status Management ........................................................................................................................... 19
11. Stack Navigation .......................................................................................................................................... 22
11.1 Internal Stack Navigation ............................................................................................................................. 22
11.2 Stack Navigation Icons ................................................................................................................................. 24
11.3 Navigating between Stack Images ............................................................................................................... 24
12. Multi-Dimensional Stacks ............................................................................................................................. 26
12.1 Grouping a Multi-Dimensional Stack ............................................................................................................ 26
12.2 Grouping All Multi-Dimensional Stacks in the Stack List ............................................................................. 29
12.3 Ungrouping Multi-Dimensional Stacks ......................................................................................................... 30
12.4 Setting the Multi-Dimensional Stacks Initial Grouping State ........................................................................ 30
12.5 Navigating Multi-Dimensional Stacks ........................................................................................................... 30
13. Window Operations ...................................................................................................................................... 31
13.1 Stacks’ Matrix ............................................................................................................................................... 31
13.2 Image Stack Location on Matrix ................................................................................................................... 35
13.3 Stack Navigation Hotkeys in Matrix Mode with Sequential Stacks .............................................................. 37
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14. Viewing Options ........................................................................................................................................... 37

14.1 Presentation State ........................................................................................................................................ 37
14.2 Lossy Mode .................................................................................................................................................. 38
14.3 Show DICOM Information ............................................................................................................................ 43
15. Image Processing Tools ............................................................................................................................... 46
15.1 Zoom ............................................................................................................................................................ 46
15.2 Window Level Control .................................................................................................................................. 49
15.3 Pan ............................................................................................................................................................... 53
15.4 Magnifier ....................................................................................................................................................... 57
15.5 Edge Enhancement ...................................................................................................................................... 60
15.6 Blending Mode ............................................................................................................................................. 63
15.7 Inverse icon .................................................................................................................................................. 64
15.8 Reset ............................................................................................................................................................ 66
15.9 Rotation Operations ..................................................................................................................................... 67
15.10 On-Image Information On/Off.................................................................................................................. 68
15.11 Palette Color ........................................................................................................................................... 69
16. Working with MPRs ...................................................................................................................................... 73
16.1 Accessing MPR Mode .................................................................................................................................. 73
16.2 Changing the Default Main Viewport Layout ................................................................................................ 75
16.3 MPR Mode Overview ................................................................................................................................... 75
16.4 Switching MPR Plane Views ........................................................................................................................ 76
16.5 MPR Controls ............................................................................................................................................... 77
16.6 MPR Tools .................................................................................................................................................... 80
16.7 MPR Visualization Tools .............................................................................................................................. 83
16.8 MPR Image Processing Tool Functionality .................................................................................................. 88
17. Creating a Secondary Derived Series .......................................................................................................... 88
18. Image Manipulations .................................................................................................................................... 91
18.1 Lock and Mark .............................................................................................................................................. 91
18.2 Lock .............................................................................................................................................................. 92
18.3 Link ............................................................................................................................................................... 93
19. Measurements.............................................................................................................................................. 97
19.1 Linear Measurement (Distance choice) ..................................................................................................... 100
19.2 Density Values Measurement (Density choice) ......................................................................................... 101
19.3 Area Measurement (Ellipse, Rectangle, Polygon Choice) ......................................................................... 102
19.4 Intersecting Angle Measurement (Angle choice) ....................................................................................... 103
19.5 Cobb Angle Measurement (Angle between Lines Choice) ........................................................................ 104
19.6 Text comment Measurement (Callout Choice) .......................................................................................... 105
19.7 Pointer Interest Annotation (Arrow Choice) ............................................................................................... 106
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19.8 Text Annotation (Text Choice) ................................................................................................................... 107

19.9 Edit Text Annotation ................................................................................................................................... 108
19.10 Calibrate ................................................................................................................................................ 108
19.11 Hide ....................................................................................................................................................... 109
19.12 Erase ..................................................................................................................................................... 110
19.13 Erase All ................................................................................................................................................ 110
19.14 Displayed Values for Area Measurement ............................................................................................. 110
20. Key Image .................................................................................................................................................. 111
20.1 Save Key Image ......................................................................................................................................... 111
20.2 Remove Key Image .................................................................................................................................... 113
21. Hanging Protocol ........................................................................................................................................ 115
21.1 Hanging Protocol Selection ........................................................................................................................ 116
22. IntelliSpace PACS DCX DICOM Printing ................................................................................................... 117
23. Printing Images from DiagNET .................................................................................................................. 117
23.1 Printing via Direct DICOM Print .................................................................................................................. 117
23.1.1 Setting the Default DICOM Printer Settings for the Station .................................................................. 117
23.1.2 Creating the Layout and Printing .......................................................................................................... 118
23.2 Printing to a PC Printer .............................................................................................................................. 120
24. Print Composer DICOM Print ..................................................................................................................... 122
24.1 Print Composer Features ........................................................................................................................... 122
24.2 Print Composer GUI Overview ................................................................................................................... 122
24.3 Print Composer On-Image State Tags ....................................................................................................... 123
24.4 Workflow..................................................................................................................................................... 124
24.5 Adding Images from DiagNET to Print Composer ..................................................................................... 124
24.6 Laying Out and Organizing Images in Page Preview ................................................................................ 130
24.7 Performing Image Manipulation in Page Preview ...................................................................................... 136
24.8 Selecting Printer and Template Settings .................................................................................................... 143
25. Advanced Tools.......................................................................................................................................... 147
26. Attachments ............................................................................................................................................... 148
27. Exporting Files............................................................................................................................................ 151
27.1 Exporting AVI files ...................................................................................................................................... 151
27.2 Exporting BMP/JPEG Files ........................................................................................................................ 153
28. Troubleshooting.......................................................................................................................................... 155
28.1 Running Movie Image Problem .................................................................................................................. 155
28.2 Sorting Problem.......................................................................................................................................... 155
28.3 Measurement Problem ............................................................................................................................... 156
28.4 “Patient has Discrepancies” Warning in the Patient Worklist ..................................................................... 157
29. Accessing the PACS Viewer from the RIS Worklist ................................................................................... 157
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30. DiagNETBase.INI Configuration File Settings ........................................................................................... 158

Index .......................................................................................................................................................................... 160
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Disclaimers
WARNING: Check minimum requirements as specified in System Requirements section. "Unable

to Run Viewer” message appears when the minimum requirements are not met.
WARNING: Check screen resolution in System Requirements section to avoid image distortion.
The Software Checks the screen resolution and advises the user if there is a problem
related to resolution.
WARNING: Image size exceeding screen resolution is automatically reduced to fit the screen.
Philips has taken additional precautions to display zoom factor on the screen.
WARNING: Due to limitations in data acquisition, Philips cannot guarantee that the
measurements are accurate for DX, CR and MG images.
Note: There is an inherent magnification effect and distortion when taking x-ray
images.
WARNING: Philips is not responsible for incorrect pixel size within images received from
modalities.
WARNING: Philips cannot guarantee that true size images will be printed accurately in the event
that the DICOM Printer is calibrated incorrectly.
WARNING: The system displays images with the same image quality as they are received. If the
source file is a low quality image, the viewer cannot improve the image quality.
WARNING: Before performing clinical interpretation of the images, validate that the printed
output is correct.
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WARNING: Before distributing the images, validate that the printed output is correct.
WARNING: Close the PACS Viewer application before removing the CD/DVD from the CD/DVD.
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IntelliSpace PACS DCX R3.2 Viewer User Guide R3.2
1. Product Features
The IntelliSpace PACS DCX DiagNET application provides medical image manipulation and post processing
software.
The advantages of using IntelliSpace PACS DCX DiagNET software are:
 Includes the most advanced features while maintaining an intuitive, user-friendly interface
 Compact in size
 Does not require installation
 Provides a single application for reading, viewing and distribution
 Compatibility with any PC meeting the minimum system requirements
 WEB enabled
2. System Requirements
The following configuration is recommended:
Minimum 2 GB RAM, recommended 4 GB

17-inch color monitor
Super VGA, 1280x1024, must support 32 bit color
CD drive
2.1 Advanced System Requirements

The following configuration is recommended when performing advanced imaging including viewing of multi-
dimensional group/ungroup and MPRs:
i7 Processor or equivalent
Recommended 8 GB RAM
Graphic card supporting:
 OpenGL: 2.2 or higher
 GPU: 100 or more, GPU cores with 1GB minimum memory
2.2 System Requirements for Stations Launching Images from a CD

Two Core DUO E2400 and up. Recommended minimum core i3.
Operating System: Windows XP 32 bit, Windows7 32/64 bit
Minimum 2 GB RAM and up
17-inch color monitor
Super VGA, 1280x1024, must support 32 bit color, resolution 19 and higher
CD drive
3. Intended Use
This application is intended for use by trained medical professionals, including but not limited to radiologists,
clinicians and technologists.
4. Reference Documents
This document references to the following documents:
 4522 170 21281 IntelliSpace PACS DCX R3.2 User Guide
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 4522 170 21311 IntelliSpace PACS DCX R3.2 Instructions of Use
5. Abbreviations
The following list defines abbreviations used in this document:
DICOM Digital Imaging and Communications in Medicine

DICOMDIR DICOM Directory File
LUT Look-Up Table
FPS Frame Per Second
MIP Maximal Intensity Pixels
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6. Study Preview Panel

This chapter describes buttons used in the image preview panel.
6.1 Collapse / Expand Studies

This button hides / displays the Stacks Preview for each Study (see Figure 1 – Figure 2).
Figure 1: Collapse / Expand button – before clicking it
All the stacks

preview are
hidden
Figure 2: Collapse / Expand button – after clicking it
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6.2 Sort Backward

This option enables you to sort studies and stacks in chronological order (See Figure 3).
Figure 3: Sort Backwards button
Clicking this button once, causes button to appear (Sort Forward). Clicking it once again,
causes the button to return to its original display.
Clicking this button once, causes button to appear (Sort Backwards). Clicking it once
again, causes the button to return to its original display.
In case of multiple study, the top sort sorts the studies and the internal one sorts the stacks / series (See Figure 4
for example).
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Top sort sorts the

studies
Internal sort sorts the

series of this study
Figure 4: Multi study example
6.3 Only Icons / Image information

This button hides all the information regarding the images. Clicking this button again displays all the information
regarding the Stack of the images (See Figure 5 – Figure 6).
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Figure 5: Only icons / image information - before clicking it
Figure 6: Only icons / image information - after clicking it
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7. Auto Hide mode

This chapter describes how to display / hide panels and toolbars
7.1 Fix
The pushpin button shows/hides the panel or toolbar.
1
2
Figure 7: Fix pushpins
Figure 7 shows the Fix pushpin buttons in the DiagNET:
1 For Study Preview Panel

2 For Image toolbar
3 For Navigation toolbar
To define defaults for all three Fix pushpin buttons go to: Options > Preferences > Main Screen > Defaults on
appearance option, in IntelliSpace PACS DCX Client screen. This option relates to all three locations (See Figure
8). Note that the sequential numbers match the numbers of Figure 7 explanations.
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1
2
Figure 8: Setting Fix pushpin defaults
1 Relates to the Image toolbar

2 Relates to the Study Preview Panel
3 Relates to Navigation toolbar
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8. Image Selection Display

In order to view a specific image use the methods mentioned below.
8.1 General Image Selection

Display a selected image can be done as follows:
Select a requested image by selecting the checkbox (located on the top right side of the image),
using the mouse, until the ‘√’ sign is seen.
Drag the requested image using the left button of the mouse from the study preview panel to the
middle of the screen.
8.2 Matrix Image Selection

Viewing a selected image on a matrix can be done according to the following:
Drag the requested image using the left button of the mouse from the study preview panel to the
requested location on the matrix.
Exchanging images is performed by dragging the required image using the left button of the
mouse from the study preview panel to the requested location on the matrix. Note that the current
image replaces the previous one.
Placing an image in an empty cell is done by dragging the required image using the left button of
the mouse from the study preview panel to the desired location on the matrix.
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9. Patient Navigation
TIME SAVER: DiagNET consists of buttons to help navigate quickly and easily in
work lists
1 2 3 4 5
Figure 9: Patient Navigation icons location
Figure 9 consists of the following icons (explanations are provided according to their sequential order):
1 To first patient icon: Click this icon to reach the first patient from the list
2 To previous patient icon: Click this icon to reach the previous patient from the list
Patients’ list icon: Click this icon in order to update a patients’ list. Clicking it displays
3
the DiagNET screen
4 To next patient icon: Click this icon in order to reach the next patient from the list
5 To last patient icon: Click this icon in order to reach the last patient from the list
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9.1 Patient Navigation in the Multi-Site Environment

The IntelliSpace PACS DCX multi-site solution provides a shared-data and shared-workflow environment enabling
access to all patients and studies located on all sites.
Viewing a study in DiagNET requires the study DICOM data to be locally stored. To enable seamless reading in
DiagNET all remote studies should be fetched to the local site. For instructions on performing manual fetch of
remote studies, refer to the “IntelliSpace PACS DCX User Guide”.
Navigating to the next or previous patient or study located on a remote site displays the following message:
“You are trying to navigate to a study that is located on a remote site. Perform Fetch in the Patient Worklist
and then retry opening it.
In the multi-site environment, all of the changes to a study including study status and addition of key images are
updated on a global multi-site level and are visible in the Patient Worklist on all sites.
If a site is disconnected, a warning message is displayed indicating that DiagNET will shut down and the latest
changes are not saved. When logging on to the PACS in this disconnected state, the local studies are viewable but
cannot be modified and the remote studies are inaccessible.
WARNING: If the site is disconnected, do not read studies if there is any doubt that the related
patient or study is not up-to-date as this may lead to incorrect diagnosis and
incorrect patient care. This is due to the fact that when a single site is
disconnected, the other sites may continue to function, adding new information
and performing modifications to the patient or study which may be vital to the
diagnosis. The missing data may include:
o Data updates in RIS which were received in form of HL7 events.
o Data updates due to Manual Data Management operations.
o All discrepancy alert icons for previous and new data are not displayed.
o Additional new data including acquired images of the study, key images,
saved MPR series, reports or attachments.
WARNING: If the site is disconnected, urgent studies must be read in the Modality workstation
or using an alternative 3rd party application.
10. Study Status Management

Study status management enables the site personnel to both update and follow a Study throughout its different
stages.
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Figure 10: Study Status option
Clicking the arrow near the button causes a drop-down list to appear (See Figure 10). Select the requested stage
according to the following possibilities:
Study Scheduled (dependent on RIS)
Study Cancelled (dependent on RIS)
Study In Progress
Unread: This status indicates that the information has been inserted in the
database and therefore, the study is ready to be viewed. It is set automatically
from Scheduled, Incoming, Cancelled and Deleted stages. Other statuses
will not be changed
Study Deleted
Open For Viewing
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Read: This status is updated automatically once exiting the DiagNET screen
Trainee Dictation Started: This option indicates that an authorized trainee

has started the dictation process
Trainee Dictated: This option indicates that an authorized trainee has

finished the dictation process
Dictation Started: This option indicates that dictation by an authorized

person has begun
Report Dictated: This option indicates that a report has reached dictated
stage
Preliminary Report: This option indicates that all the diagnostic stages are
updated to one report
Report Corrected: This option indicates that a corrected report is available
Report Verified: This option indicates that a verified report is available
Final Report: This option indicates that all the diagnostic stages are updated
into a final report
Report Approved: This option indicates that the final report has been
approved
Second Approve: This option indicates that the final report has been
approved for the second time
TIME SAVER: User can set automatic changes of study status upon entering and
exiting DiagNET. This feature can be configured per user in DiagNET user options.
TIP: Study Status list can be defined per site by the System Administrator
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11. Stack Navigation

Use the buttons below to navigate in and between the stack images.
11.1 Internal Stack Navigation
Figure 11: Stack Navigation icon location
Click button to navigate through the images within a stack. This is done by the following method:
Select the required multi-image/frame stack to start with
Click the button ( )

Click and hold the left button of the mouse
1) Move the mouse up or down: note that the default order of the images is from head to
toe. In this way, moving the mouse upwards – leads to the previous image, and moving
the mouse downwards – leads to the next one. When the order of the images is from toe
to head, moving the mouse upwards – leads to the next image, and moving the mouse
downwards – leads to the previous one.
2) Navigation by using mouse wheel: downwards – navigation in the stack until it ends.
Upwards – navigation in the stack until reaching the beginning.
3) Use arrow keys from the keyboard: downwards – navigation from the first image to the
last one. Upwards – navigation from the last image to the first one
NOTE: In single stack cases, the navigation button does not exist.
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11.1.1 Image Navigation toolbar

Every stack window containing more than one image displays a navigation bar (See Figure 12).
1 2 3 4 5 6 7 8 9 10 11 12
Figure 12: Image toolbar navigation
Figure 12 consists of the following (explanations are provided according to their sequential order):
1 To next – Move to next either frame or image

To next page – Move to next page (moves to next group when using a matrix
2
layout)
3 To last – Move to last either frame or image
4 To first – Move to first either frame or image
To previous page – Move to previous page (moves to next group when using a
5
matrix layout)
6 To previous – Move to previous either frame or image
7 Run forward - Play forward (as movie)
8 Loop – Play the image continuously without stopping (as movie)
9 Run backward - Play backwards (as movie)
10 FPS - Set movie frame rate (frames per second)
11 Cine cursor - Jog shuttle enables user to grab the tab (press and hold the left
mouse button) and navigating through the stack by moving left or right
12 Fix – causes the navigation bar to be displayed
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11.2 Stack Navigation Icons

Use the buttons below to navigate between the stack images.
1 2 3 4
Figure 13: Stack Navigation icons location
Figure 13 contains the following icons (explanations are provided according to their sequential order):
1 To first stack: Click this icon to reach the first stack

2 To previous stack: Click this icon to reach the previous stack
3 To next stack: Click this icon to reach the next stack
4 To last stack: Click this icon to reach the last stack
11.3 Navigating between Stack Images

This section describes the different methods for navigating within and between stacks.
11.3.1 Stack Navigation using Keyboard Shortcuts

The following table describes the keyboard shortcuts for navigating between stacks:
Keyboard Shortcut Action

Home Navigates to the first stack.
End Navigates to the previous stack.
Page Up Navigates to the previous stack.
Page Down Navigates to the next stack.
The following table describes the keyboard shortcuts for navigating between stacks in a matrix:
Keyboard Shortcut Action

CTRL+ Page Down Navigates to the previous matrix page.
End Navigates to the previous stack.
Page Up Press Page Up to go to the previous stack.
Page Down Press Page Down to go to the next stack.
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The following table describes the stack navigation keyboard arrows

Keyboard Arrow Action
Right Arrow Navigates within the stack and moves to the next stack.
Left Arrow Navigates within the stack and moves to the previous stack.
Up Arrow Navigates within the stack and moves to the next stack.
Down Arrow Navigates to the previous stack.
11.3.2 Navigating within and between Stacks Using the Mouse

Navigation using the mouse wheel:
 Scrolling downwards – navigates in the stack (from first image to last) and moving to the
next stack.
 Scrolling Upwards – navigates in the stack (from last to first) and moving to the previous
stack.
NOTE: Navigation in CT and MRI stacks stops at the last image and does not proceed to the next stack.
This is due to the default configuration in the DiagNETBase.ini file. For more information see the
DiagNETBase.INI Configuration File Settings section.
NOTE: When using the Matrix option, every method explained above is relevant as well.
11.3.3 Navigating between Studies

Study navigator (Figure 14) provides navigation into the study according to the following:
Figure 14: Study Navigator
Enables linear run through stacks within the study

Toggle play forward and backward
You can display the navigator for all stacks automatically by selecting: Options > Preferences > Main Screen >
Auto-play all stacks option, in IntelliSpace PACS DCX Client screen (see Figure 15).
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Figure 15: Auto play all stacks option
NOTE: Multi study navigation is done by using either the mouse wheel or arrow keys between the stack
images.
During navigation, Figure 16 appears
Figure 16: Multi study warning message
Click on OK button for confirmation. Otherwise, click on Cancel button.
12. Multi-Dimensional Stacks

The Viewer supports grouping multi-dimensional stacks according to phases for CT and MRI series.
NOTE: For best performance of the Group/ Ungroup of multi-dimensional stacks feature it is
recommended to use dedicated hardware that is described in the Advanced System Requirements section.
12.1 Grouping a Multi-Dimensional Stack

The stacks can be grouped into one stack or split into phases. The series is grouped according to best possible
options, according to the image tags, which will not necessarily result in one stack. For example, functional MRI
may result in two or more stacks.
NOTE: When exporting multi-dimensional grouped images in a matrix larger than 1x1, the Export to AVI
tool creates separate files for all the visible phases.
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To group/ungroup multi-dimensional stacks:

A ‘Group multi-dimensional’ icon is displayed next to each stack
1. Hover over the icon in the relevant stack to display the associated stacks related to this group.
Figure 17: Ungrouped Multi-Phase Stacks
2. Select the icon in the relevant stack in the stack list.
Figure 18: Grouped Multi-Phase Stacks
The stack phases are grouped and the icon changes to .

3. Select the relevant grouped stack and select an internal matrix to view the different phases.
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Figure 19: Selecting an internal Matrix
The two phases are displayed side by side within the defined matrix.
Figure 20: Grouping Multi-Dimensional Stacks
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12.2 Grouping All Multi-Dimensional Stacks in the Stack List

To group all the multi-dimensional stacks in the stack list:
 Select the icon in the study tool bar.
Figure 21: Selecting the ‘Multi-Dimensional Group- All’ icon
As displayed in Figure 21, all the multi-dimensional stacks can be grouped.

Both SE#301 and SE#302 respectively contain 24 images in phase 1 and 24 images in phase 2.
In Figure 22, SE#301 and SE#302 are grouped each containing 48 images.
Figure 22: Grouped Multi-Dimensional Phases
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12.3 Ungrouping Multi-Dimensional Stacks

Ungrouping the multi-dimensional stack returns the stacks to the original state.
To ungroup multi-dimensional stacks, do one of:
 Ungroup single multi-dimensional group: Click the icon in the related stack to ungroup a single multi-
dimensional stack
 Ungroup all multi-dimensional groups: Click the icon above in the study taskbar to ungroup all the dimensional
stacks.
12.4 Setting the Multi-Dimensional Stacks Initial Grouping State

The Group/Ungroup initial state can be configured in the DiageNETbase.ini. The default initial state is
ungrouped.
To set the multi-dimensional stacks to be grouped when opening DiagNET:
1) Access the DiageNETbase.ini file as described in the ‘DiagNETBase.INI Configuration File Settings’
section.
2) Navigate to the following section:
[MULTI-DIMENSIONAL]
InitStateGrouped = 0
0 :default value means ungrouped
3) Change the value from ‘0’ to ‘1’ in the InitStateGrouped = ‘1’.
4) Save and close the file.
12.5 Navigating Multi-Dimensional Stacks

DiagNET provides multi-dimensional stack navigation according to different phases. Navigation can be performed
according to phase or position.
The following table describes the multi-dimensional stacks navigation functionality:
Function Action
Navigate per position in each phase. Press the ‘left mouse button’ and drag the mouse
vertically.
Navigate between the phases Press ‘Ctrl+’ and the ‘left mouse button’ and drag the
mouse horizontally.
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13. Window Operations

This chapter describes how to use matrixes to display stacks in the DiagNET.
13.1 Stacks’ Matrix

This option enables to divide the screen to a matrix according to a defined number of cells.
Figure 23: Stacks’ Matrix button
Click this icon (Figure 23) to either define or change the stack matrix layout. Clicking this icon leads to Figure 24.
A 2x2
matrix
example
Figure 24: Matrix button
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Dragging the bottom either left or right corner of the box changes the matrix size.
Viewing an image in a split window can be done. In such a way, previous images can be tested with the current
ones. In order to use this possibility do the following:
Press the button and select the desired matrix size (see Figure 24). For example, if four
images are to be displayed in one screen, arranged in two rows and two columns, select the
matrix (see Figure 24). This is done by selecting both the rows and columns using the mouse. As
a result, the images will be arranged as a four image table (Figure 25).
Figure 25: 2x2 matrix image example
Double clicking an image within the matrix maximizes the image over the complete stack window
area.
Double clicking again restores the matrix view.
Alternatively pressing the and buttons causes a switch between maximize and
restore mode of a window.
Pressing the X icon closes the sub window.
13.1.1 Internal Matrix

This option enables to define an internal matrix. Internal matrix can be done for multi- frame stack, and in addition
this can be done provided a matrix already exists (Figure 25).
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Active sub matrix window
Internal matrix example

defined as a 4x4 one
Figure 26: Internal matrix example
This is done according to the following:
Place the mouse on the requested sub matrix window. Note that the active sub matrix window
consists of an orange frame around it. Moreover, on the left side of the screen the same image is
displayed with a white frame around it as well (as demonstrated in Figure 26).
Click the icon (see Figure 27) and define the matrix size.
In order to enlarge a specific image on the internal matrix (to the size of the matrix window), place
the mouse on the requested one and double click it. Double clicking it once again, causes the
original internal matrix to be displayed.
Figure 27: Internal Matrix icon location
The size of an internal matrix can be changed according to the following:
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Right click on multi-frame image (Figure 27). Select the Matrix option.
Figure 28 and Figure 29 are displayed. Drag the bottom either to the left or to the right corner of
the box changes the matrix size.
Figure 28: Right click of multi-frame image options
Figure 29: Internal matrix size
13.1.2 Navigating within the Internal Matrix

Hotkey Functionality
Up Arrow, Down Arrow The next sequential images in the stack are displayed in the matrix.
Left Arrow, Up Arrow The previous sequential images in the stack are displayed in the matrix.
Ctrl +, Ctrl + Down Arrow The next sequential images in the stack are displayed in the matrix.
Ctrl +, Ctrl + Up Arrow The previous sequential images in the stack are displayed in the matrix.
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13.2 Image Stack Location on Matrix

This option enables placing a selected image elsewhere in an existing matrix.
Figure 30: Placing Matrix on any cell icon location
Click this icon (Figure 30) to place the selected image on a different location on an existing matrix. This is done by
the following:
Place the mouse on the bottom of a requested stack preview. An icon bar consisting of two icons
is seen (see Figure 30). Click the left one.
An indication of the matrix is displayed (see Figure 31).
Select the location in the matrix indication and this position is marked in black. Click the desired
new location and the matrix images change accordingly.
In this example, the selected

image moves to the first
location in the matrix
Figure 31: Indication matrix location
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It is possible to update the image location according to the following:
Use icon to move a selected image to an updated location on the matrix.

Click the mouse on the requested stack preview image and drag it to the desired location on the
matrix.
Place the mouse on the requested sub matrix window and drag the requested image to the
desired location on the matrix. Note that the active sub matrix window consists of an orange
frame around it. Moreover, on the left side of the screen the same image is displayed with an
organe frame around it as well.
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13.3 Stack Navigation Hotkeys in Matrix Mode with Sequential Stacks

Hotkey Functionality
Home The first sequential stacks are displayed in the matrix.
End The last sequential stacks are displayed in the matrix.

Ctrl +'Page Down' The next sequential number of stacks is displayed in the matrix.
Ctrl +'Page Up' The previous sequential number of stacks is displayed in the matrix.
14. Viewing Options

This chapter consists of options regarding viewing images.
14.1 Presentation State

This button enables you to apply a presentation state to an image.
Figure 32: Presentation State icon image location
This option (Figure 32) can also be reached by right-clicking (Figure 33).
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Figure 33: Presentation State via right click
This selection enables the user to define how to present an image. This option appears only when presentation
states are available in the DICOM file.
NOTE: Some Presentation states can be defined for one stack.
14.2 Lossy Mode

This option causes an image to be in Lossy mode.
This option can be reached using the following possibilities (refer to the relevant option):
Stack
Study
All Studies
Per Stack
Option number 1: right-click the mouse located on an image and select Lossy mode > Set Lossy Stack option
(Figure 34).
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Figure 34: Set Lossy Stack option via right click
Option number 2: Place the mouse on the bottom of a requested stack preview image. An icon bar consisting of
two icons is seen (see Figure 35). Click the Set Lossy mode one.
Place the mouse on the bottom of a requested stack preview image. Click the Set Lossless mode - Set Lossless
Mode to the current stack.
Figure 35: Set Lossy mode option per stack icon location
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Per Study
Choose the requested selection:
Right-click on an image and select the following option – Lossy mode > Set Lossy Study.
Define Lossy option to the stacks of images in a specific study.
Click the icon seen in Figure 36
Figure 36: Set Lossy Compression to the study icon location
After selecting this option, Figure 31 appears.

Figure 37Click the OK button to confirm stack initialization. Otherwise, click the Cancel button.
Figure 37: Stack Initialization confirmation window
Click Set Lossy Compression to the study icon once again.
Right-click on an image and select Lossy mode > Lossless mode option - Set Lossless Mode
to the current study.
After selecting this option,
Figure 37 appears. Click the OK button, to confirm stack initialization.
NOTE: Stack Initialization message (Figure 38) appears if Lossy Compression Usage options are
marked (this is done by marking: Options > Preferences > Performance > Lossy compression usage
options, in IntelliSpace PACS DCX Client screen (see Figure 39).
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Figure 38: Stack Initialization confirmation window
Figure 39: Lossy Compression Usage options
Per All Studies

Choose the requested selection:
Right-click the mouse located on an image and select the following – Lossy mode > Set all
Lossy: Define Lossy mode to all studies.
Click the button shown in Figure 40.
After selecting this option,
Figure 37 appears. Click the OK button, to confirm stack initialization. Otherwise, click the
Cancel button.
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Figure 40: Set Lossy Compression to the all studies icon location
Click Set Lossy Compression to the all studies icon once again.
Right-click the mouse located on an image and select Lossy mode > Lossless mode option -
Set Lossless Mode to the all studies.
After selecting this option, Figure 31 appears.
Figure 37 Click the OK button, to confirm stack initialization.
NOTE: Whenever Lossy mode to all studies icon is set and DiagNET is open for another patient, causes
all his studies to be in Lossy mode.
Once this option is done, the image is marked with a LOSSY caption both in the top left side of the selected image
and on the image itself when viewed (see Figure 41 for example).
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Lossy indication
is displayed
Figure 41: LOSSY caption example
NOTE: Lossy mode is for quick access purposes and does not serve as a diagnostic tool
14.3 Show DICOM Information

This option enables to view information regarding DICOM file.
When you click this button DICOM information is displayed (Figure 42).
DICOM
information is
stated here
Figure 42: Show DICOM Info icon location
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A B C D E
Figure 43: DICOM Info icons
The DICOM information part consists of the following icons (see Figure 43) explained in alphabetic order:
A Search field: insert relevant text to search through the information displayed below.
B Search Next icon: click it to view the next time the text inserted in Search field is seen
in the information displayed below.
C Copy icon: copy relevant information. Usually is used when search is needed.
D Image number field: states the current image number out of the total images. For
example, image number 1 displayed out of 3 images will be seen as: ‘1/3’.
E Expand Info icon: click this to enlarge the DICOM information stated below the image
(see Figure 44).
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Figure 44: Expand Info icon result
It is possible to cause the DICOM information to be displayed automatically by marking: Options > Preferences >
Main screen > Show content of DICOM header option, in IntelliSpace PACS DCX Client screen (see Figure
45).
Figure 45: Show content of DICOM header
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15. Image Processing Tools

This chapter describes image manipulation tools, such as: zoom, and pan.
15.1 Zoom
This option enables zooming images.
Do one of the following to access the zoom tool in DiagNET:
 Select the Zoom icon from the toolbar.
Screen - Figure 46
Image - Figure 47
Figure 46: Zoom icon screen location
 Select the Zoom icon on the image.
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Figure 47: Zoom icon image location
 Using the mouse, select the mouse wheel + right button.

 Using the mouse + keyboard, select Ctrl + mouse wheel.
It is possible to define the zoom percentage every image begins with. This is performed by selecting this percentage
from the drop down list of Zoom option by going to: Options > Preferences > Tools > Zoom option, in
IntelliSpace PACS DCX Client screen (see Figure 48).
Figure 48: Zoom option selection
Click this icon to zoom a specific item in an image as follows:
Select the required image to be displayed.
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Click the icon ( )

Click and hold the left button of the mouse.
Drag the mouse towards up – the image zoom increases (Figure 49). Drag the mouse towards
down – the image zoom decreases (Figure 50). It is possible to use Ctrl + Mouse wheel for this
purpose as well.
Figure 49: Zoom icon – example number 1
Figure 50: Zoom icon - example number 2
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Using Zoom option can be reached by using right click mouse on the selected displayed image (see Figure 51).
Another possibility is using right click mouse for fixed options selection of zoom (see Figure 52).
Figure 51: Zoom option using right click
Figure 52: Another Zoom option via right click
15.2 Window Level Control

This option enables to change the Window Level of an image.
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There are two locations of Window Level Control icons:
Screen - Figure 53
Image - Figure 54
Figure 53: Window Level Control icon screen location
Figure 54: Window Level Control icon image location
Click this icon to change the Window Level as follows:
Choose the requested image to be displayed.
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Click the icon ( )

Drag the mouse downwards – the image darkens (Figure 55). Drag the mouse upwards – the
image brightens (Figure 56).
Press and hold the left mouse button over the image: Drag the mouse left/right – the width of the
image LUT changes. Drag the mouse up/down – the center of the image LUT changes.
NOTE: Pressing the mouse wheel and dragging it produce the same result regardless of the selected tool.
Figure 55: Dark image example
Figure 56: Bright image example
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When Window Level icon is active, right clicking the mouse enables to select Full range (see
Figure 57).
Pressing F5 key from the keyboard sets the Full Range option.
To use the Window Level Control option right-click on the selected image (Figure 58).
Figure 57: Window Level Control via right click
Figure 58: Full range option
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15.2.1 Window Level Presets
The user can select from the drop list preconfigured presets for Center and Width values (see
Figure 53 for example).
Pressing F6 key from the keyboard cycles through the available Window Level presets.
The same
preset
selected in
the
context
menu is
displayed
on the left
bottom
corner of
the screen
Figure 59: Window Level presets example
15.3 Pan
This option enables to move images to different locations on their image screen.
Do one of the following to access the pan tool in DiagNET:
 Select the Pan icon from the toolbar.
Screen - Figure 60
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Figure 60: Pan Icon screen location
 Select the Pan icon on the image
Figure 61: Pan Icon image location
 Using the mouse, select the mouse wheel + left button.

Click this icon to move the location of the image in the screen. This is done according to the following:
Select the required image to be displayed.
Click the icon.

Drag the mouse to a desired location. The image moves in the same direction as the mouse (see
Figure 62 for example).
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Figure 62: Pan icon image example
When Linking two (or a few images) images and using the Pan function, you can do the following:
Moving the images in the same direction (Figure 63 for example).

Moving the images in the opposite direction (such as in Figure 64).
Figure 63: Moving the images to the same direction example
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Figure 64: Moving the images to opposite directions example
When the Pan icon is active, you can right-click and select horizontal opposite panning (see Figure 65). Pressing
[shift] key while dragging the mouse also results in horizontal opposite panning. This option can be used for linked
stack images in Matrix mode.
NOTE: Opposite panning operates only in link mode.
NOTE: Opposite panning is relevant to Mammography images.

Using the Pan option can be reached by using right click mouse on the selected displayed image (see Figure 65 -
Figure 66).
Figure 65: Opposite panning option
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Figure 66: Pan option via right-click menu
15.4 Magnifier
This option enables you to enlarge specific areas in an image.
There are two Magnifier icons:
Screen - Figure 67
Image - Figure 68
Figure 67: Magnifier icon screen location
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Figure 68: Magnifier icon image location
Click this icon to enlarge different locations on the image. This is done according to the following steps:
Select the required image to be enlarged.
Click the icon until a magnifier shape appears (as defined in: Options > Preferences >
Diagnostic Preferences > Tools, in IntelliSpace PACS DCX Client screen – see Figure 69). In
addition, you can define the size, zoom and shape units of the magnifier.
Drag the magnifier shape using the mouse to a required location on the image (see Figure 70 for
example).
Further options
regarding
Magnifier definition
Figure 69: Magnifier Shape definition screen
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Figure 70: Magnifier example
When Magnifier icon is active, right clicking the mouse enables to select the requested size and Magnification
factor, size and shape (see Figure 71). Using Magnifier option can be reached by using right click mouse on the
selected displayed image (see Figure 72).
Figure 71: Magnifier icon options
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Figure 72: Magnifier option via right click
15.5 Edge Enhancement

This option enables to sharpen an image.
There are two Edge Enhancement icons:
Screen - Figure 73
Image - Figure 74
Figure 73: Edge Enhancement icon screen location
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Figure 74: Edge Enhancement icon image location
Click this icon to sharpen an image. This is performed according to the following:
Select the required image to be sharpened.
Click the icon.

Drag the mouse towards down – sharpening of the image increases (Figure 75). Drag the mouse
towards up – sharpening of the image decreases and un-sharpens it (Figure 76).
Figure 75: Edge Enhancement icon example – before sharpening
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Figure 76: Edge Enhancement icon example – after sharpening
Using Edge Enhancement option can be reached by using right click mouse on the selected displayed image (see
Figure 77).
Figure 77: Edge Enhancement option via right click
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15.6 Blending Mode

This option allows changing the level of subtraction (Figure 78).
Figure 78: Blending Mode icon location
This is performed according to the following:
Select the required image to be blended.
Click the icon.

Press and hold the left mouse button over the image and drag the mouse towards up - to un-
subtract. Drag the mouse towards down - to subtract (Figure 79).
Figure 79: Blending Mode example
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NOTE: This function is only possible on subtracted angiography (XA) images.
15.7 Inverse icon

This option performs the inversion of the image colors.
There are two Inverse icons:
Screen - Figure 80
Image - Figure 81
Figure 80: Inverse icon screen location
Figure 81: Inverse icon image location
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This is done according to the following:
Select the required image to be inversed.
Click the icon. The colors of the selected image have been inversed (Figure 82).
Using Inverse option can be reached by using right-click mouse on the selected displayed image (see Figure 83).
Figure 82: Inverse example
Figure 83: Inverse option via right click
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It is possible to define the inverse option to be automatically set whenever DiagNET starts. This is done by marking:
Options > Preferences > Diagnostic Preferences > Tools > Inverse option, in IntelliSpace PACS DCXClient
screen (see Figure 84).
Figure 84: Inverse option selection
15.8 Reset
This option enables to reset all the attributes to their default settings.
There are two locations of Reset icons:
Screen - Figure 85
Image - Figure 86
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Figure 85: Reset icon screen location
Figure 86: Reset icon image location
15.9 Rotation Operations

You can perform the following rotation operations:
To rotate an image 90° counter clockwise using the icon, right-click and select Rotate >
Left.
To rotate an image 90° clockwise using the icon, right-click and select Rotate > Right.
To flip an image horizontally using the icon, right-click and select Rotate > Flip Horizontal.
To flip an image vertically using the icon right-click and select Rotate > Flip Vertical
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15.10 On-Image Information On/Off

This option enables a display of all information on an image.
Image information is seen

on both sides when this icon
is active. Otherwise, the
information is hidden
Figure 87: On-Image Information On/Off icon image location
Use this button (Figure 87) to view the relevant DICOM information regarding the image. When this icon is active
(on state) the information is displayed. Otherwise, it is not displayed (off state).
It is possible to define on image information to begin with every time DiagNET begins. This is done by marking:
Options > Preferences > Diagnostic Preferences > Main screen > Show on-image information option, in
IntelliSpace PACS DCX Client screen (see Figure 88).
Figure 88: Show on-image information selection
NOTE: If the image is decreased in a way that causes the information font to be too small, the
information is not displayed.
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15.11 Palette Color

This option allows applying a palette color to an image.
There are two locations of Palette Color icons:
Screen - Figure 89
Image - Figure 90
Figure 89: Palette Color icon screen location
Figure 90: Palette Color icon image location
This is performed according to the following:
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Select the required image to be inversed.
Click the icon. A palette color has been applied (Figure 91).
Figure 91: Palette color example
It is possible to define Palette Color option as seen in Figure 92 as follows:
Go to: Options > Preferences > Definitions > Main screen section in IntelliSpace PACS DCX
Client screen.
Select the following: default color palette and whether to automatically apply palette color.
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Figure 92: Palette Color option
When Palette Color button is active, right clicking the mouse enables to select the requested palette color choices
(see Figure 93).
Figure 93: Palette Color options using right click
Using Palette Color option can be reached by using right click mouse on the selected displayed image (see Figure
94).
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Figure 94: Palette Color option via right click
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16. Working with MPRs

The Multi-Planar Reconstruction (MPR) feature supports viewing original spatial DICOM image series in different
projections (Axial, Coronal, Sagittal or Oblique), different visualizations (MIP, Weighted MIP, Average, etc.), and
different slice thicknesses.
NOTE: For best performance of MPR viewing, it is recommended to use dedicated hardware that is
described in the Advanced System Requirements section.
Using MPR, it is possible to create a new derived DICOM series based on the selected projection and slice
thickness. For more information, refer to Creating a Secondary Derived Series.
16.1 Accessing MPR Mode

To access the Multi-Planar Reconstructions (MPR) mode, do one of the following:
 Select the required DICOM series and click the MPR icon (see Figure 95).
Figure 95: Accessing MPR mode via the MPR icon location
NOTE: The icon is active only once the series is fully loaded.
 Select MPR Mode from the right-click menu (see Figure 96).
Figure 96: Accessing MPR Mode via Right-Click
MPR functionality is enabled and the following features are added to the drop-down menu.
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Figure 97: MPR Mode Functionality added to Right-Click Menu
The initial MPR window opens displaying the Acquisition Plane. The Oblique view is displayed in the main viewport
and the referenced views are displayed in the right viewports.
Figure 98: MPR Mode Acquisition Plane with 1+3 Viewports
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You can perform the following viewport layout changes:
To move and maximize a reference viewport to the main viewport:

 Double-click in the reference viewport area.
To change the viewport layout:
 Double-click the main image to switch to the 2X2 layout.
 Double-click to return to the 1+3 layout.
16.2 Changing the Default Main Viewport Layout

The DiageNETbase.ini determines that default main layout in which MPR mode initiates is the 1+ 3 window layout,
whereby the Oblique view is displayed in the main viewport.
To change the main view to 2X2:
5) Access the DiageNETbase.ini file as described in the ‘DiagNETBase.INI Configuration File Settings’ section.
6) Navigate to the following section:
[MPR]
ObliqueMainView = 1
;1 - default value
1 = 1+3 layout
0 = 2x2
7) Change the value from ‘1’ to ‘2’ in the ObliqueMainView = ‘2’.
8) Save and close the file.
16.3 MPR Mode Overview

Figure 99 displays the MPR mode components.
Figure 99: MPR Mode Components
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The following table describes the MPR Mode components:
ID Component Description
1 MPR Views The MPR views are:
a Oblique (Main Views)
b-d Referenced View
Note: The projections labels (Axial, Coronal and Sagittal) are displayed only in
the Patient Plane.
2 MPR icons on the : Access MPR Mode
Toolbar
: MPR Tools
3 Selected MPR Stack In the study list, MPR Stacks are displayed in the MPR mode with an orange
border.
4 Thickness Value Displays the slab thickness in each viewport.
5 3D Axis Displays the body position in relation to the axis determined by the other views.
6 MPR Controls Blue dot: Indicates the rotation center.

Two red dots: Indicate the slab thickness.
Blue line: Indicate the Slab Rotation.
For detailed information, refer to the “MPR Controls section”.
16.4 Switching MPR Plane Views

This section describes switching the supported DiagNET MPR Plane View.
16.4.1 Moving between the Acquisition Plane and the Patient Plane
DiagNET supports two MPR plane views, the Acquisition plane view which is the default view and the Patient plane
view. The Acquisition plane view displays images according to the image set orientation, whereas the Patient plane
view displays images according to the patient anatomical view.
To differentiate between the views, only the Oblique label is displayed in the Acquisition plane view whereas in the
Patient plane view all the 4 views are labelled Oblique, Axial, Coronal and Sagittal.
To move to the Patient plane view:
1. Access MPR Mode.
2. Right-click and select Patient Plane.
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Figure 100: Moving to Patient Plane
16.4.2 Changing the Default MPR Plane View

The default MPR pane view is configured per station and can be configured locally in the DiagNETBase.ini file.
To change the default MPR Plane view:
1. Access the DiageNETbase.ini file as described in the ‘DiagNETBase.INI Configuration File Settings’
section.
2. Navigate to the [MPR] section, Change ‘0’ to ‘1’ as follows:
PatientPlaneView=1
Syntax Description:
o Acquisition View = 0
o Patient View = 1
3. Save and close the file.
The MPR automatically opens in the Patient Plan view once DiagNET opens.
16.5 MPR Controls

DiagNET provides a set of controls for performing multi-oblique MPR operations.
This section describes the supported MPR controls including the Dynamic Rotation Center, Slab Thickness and
Slab Rotation.
16.5.1 MPR Dynamic Rotation Center Control
The Dynamic Rotation Center is represented as the blue dot on the images in MPR mode. Moving the dynamic
rotation center in the projections causes the Oblique view to be rotated according new rotation center.
To move the MPR Rotation Center:
1. Click the blue dot on any of the projections.
A yellow mouse cursor is displayed.

2. Drag the mouse to the selected destination.
As illustrated in Figure 101: Moving the Rotation Center in the reference views moves the rotation center in all
views respectively.
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Figure 101: Moving the Rotation Center
Figure 102: Multi Oblique Rotation Show with Rotation

As illustrated in Figure 102, the Oblique view rotates according to the new rotation center.
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16.5.2 MPR Slab Thickness Control

The MPR slab thickness control is applicable only to the Axial, Coronal and Sagittal projections.
The slab thickness initial state is marked with two red dots on the blue line. Increasing the slab thickness in
reference projections is represented by two red lines and thickness value is updated in the Oblique view.
To change the slab thickness:
1) Move the mouse over one of the red dots.
The ‘Slab Thickness’ mouse curser is displayed over the red dot.
Figure 103: Slab Thickness Cursor

2) Hold and drag the mouse up or down to change the slab thickness.
As displayed in Figure 104, two parallel red lines and the slab thickness value is displayed.
Figure 104 Using the Slab Thickness Control
16.5.3 MPR Slab Rotation Control
The MPR slab rotation control is applicable only to the reference views.
To rotate the Oblique view:
1) Press and hold the left mouse button on the blue line in one of the reference views.
The slab rotation control is displayed.
2) Move the mouse to rotate the blue line in the required direction.
The Oblique view rotates and the 3D axis in the Oblique view is rotated respectively.
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Figure 105 Using the Slab Rotation Control
16.6 MPR Tools

MPR tools are added to the image toolbar and the right-click menu once MPR mode is activated (see Figure 106
and Figure 107).
1 2 3
Figure 106: MPR icons location
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Figure 107: MPR Project Manipulation Icons
16.6.1 MPR Positioning

MRP Positioning is the active MPR tool when switching to MPR mode.
To activate positioning/navigation in MPR mode, do one of:
 Click the Position icon.
 Select Position from the right-click menu.
To change the position on a selected viewport:
1. Press and hold the left mouse button on any of the projections (Axial, Coronal, and Sagittal) and Oblique
plane.
2. Move the mouse up and down.
Navigation is performed on the selected view causing reflections to change in the other viewports.
16.6.2 MPR Slab Thickness

The slice thickness value is displayed in the left bottom side of each viewport.
To change the slab thickness:
1) Click on the MPR Slab Thickness icon or select Thickness from the right-click menu.
2) Press and hold the left mouse button on any of the views. Move the mouse up and down to
change the slab thickness.
For Oblique view, use of the slab thickness controls on the reference views.
Figure 108 illustrates moving the slab thickness view in the Oblique view which causes the slab thickness to
change in all views. Red borders are added to the reference views indicating the slab thickness.
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Figure 108: Changing the MPR Slab Thickness
16.6.3 MPR Swivelling

The rotation tool is applicable only to the Oblique view and reflects the movement in the reference views. Using the
Swivel t
To perform 3D Rotation:
 In the Oblique view, click on the Slab Rotation icon or click Slab Rotation from the right-click menu.
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Figure 109: Swivelling the MPR
The image in the Oblique view is swiveled in relation to the views displayed in the reference portviews and the 3D
axis in the right-hand corner indicates the position of the image in relation to the left pane port views.
To perform 2D Rotation, do one of:
 In the one of the reference view, click on the Slab Rotation icon or click Slab Rotation from the right-click
menu.
 Using a rotation control on any of the reference views.
16.7 MPR Visualization Tools

In addition to the various MPR editing tools available, the visualization of how the images are projected can be
modified as well.
Explanations of the MPR visualizations, highlighted in Figure 110, are given in the sections below according to the
same sequential order they appear in the image.
The view algorithm can be changed according to the user selection for the following options:
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Figure 110: MPR Visualizations
16.7.1 Average Pixels-Value-Algorithm

An average pixels value is a computer visualization method for 3D data that projects in the visualization plane the
volumetric pixels with average intensity that fall in the way of parallel rays traced from the viewpoint to the plane of
projection.
To access the feature:
Select Average pixels-value-algorithm from the right-click menu (see Figure 111).
Figure 111: Average pixels-value-algorithm option via right click
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16.7.2 Weighted Average Pixels-Value-Algorithm

Weighted average pixels value is a reconstruction algorithm in which average intensity is calculated according to
weighting of pixel value.
Select Weighted average pixels-value-algorithm from the right-click menu (see Figure 112).
Figure 112: Weighted Average pixels-value-algorithm option via right click
16.7.3 MIP-Algorithm
A MIP is a computer visualization method for 3D data that projects in the visualization plane the volumetric pixels
with maximum intensity that fall in the way of parallel rays traced from the viewpoint to the plane of projection.
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Select MIP-algorithm from the right-click menu (see Figure 113).
Figure 113: MIP-algorithm option via right-click
16.7.4 Weighted MIP-Algorithm

Weighted MIP is an algorithm for reconstruction when maximum intensity is calculated according to weighting of
pixel value. Weighted MIP produces higher local contrast than compositing by average.
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Select Weighted MIP-algorithm from the right-click menu (see Figure 114).
Figure 114: Weighted MIP-algorithm option via right-click
16.7.5 Volume Rendering
Volume rendering is only applicable in Oblique view and uses transparency, colors and shading to provide a better
representation of the image. For example, the bones of the pelvis could be displayed as semi-transparent, so that,
even at an oblique angle, one part of the image does not conceal another.
To activate volume rendering:
Select Volume Rendering from the right-click menu (see Figure 115).
Figure 115: Volume Rendering option via right-click
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16.8 MPR Image Processing Tool Functionality

The image manipulation tools function as follows in MPR mode:
 Zoom is performed according to the window (camera) center (not the rotation center), for the selected
viewport.
 Pan is performed for the selected viewport.
 Window Level is adjusted to all viewports simultaneously.
 Measurements are enabled on all viewports except for Oblique view.
 Key Images and Secondary Captures are supported.
 DICOM print is enabled for the multi-oblique.
17. Creating a Secondary Derived Series

From MPR Mode, DiagNET provides the ability to create a secondary derived DICOM series. The new image series
will be created according to various parameters received from MPR and edited by the user (such as set thickness,
location, and tilt). Once created, this new series will be accessible immediately in DiagNET and will be saved to the
patient archive.
Important NOTE: Creating a secondary derived series is only possible for users with Export
Data rights in the User Data rights.
NOTE: A secondary MPR group will be created only for the active phase, (when hovering over
the mouse) for multi-dimensional groups.
To create a secondary MPR series:

Select the required DICOM series and toggle to MPR Mode.
Apply all necessary modifications with the MPR tools available, and apply any required visualization
projections to the image series (see 16. Working with MPR).
Select Create secondary MPR series from the right-click menu (see Figure 116).
The Secondary MPR Series Creation dialog is open (see Figure 117).
Figure 116: Create Secondary MPR Series
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Figure 117: Secondary MPR Series Creation
Edit the settings required by dragging the reference lines (range and number of slices) in the images
shown.
The following settings can be manually edited:
 Image projection (from the drop-down menu). The projections available depend on the currently
selected view (Axial, Coronal or Sagittal).
 Space Between Slices, (mm)
 Protocol Name (tag will be automatically added to the new DICOM Series)
 Series Description (tag will be automatically added to the new DICOM Series)
NOTE: Slice Thickness settings can only be changed in MPR Mode. If any changes are required,
return to MPR mode, change the thickness and follow the Secondary Series Creation
procedures.
NOTE: Number of Slices is displayed for user convenience and shows the number of slices that
will be created according to the parameters set (slice thickness, space, between slices and
range).
NOTE: The Performing Physician tag will be automatically added to the new DICOM series
according to the Description (e.g. Real user name) of the User currently logged-in to the system.
Note that the description field is not mandatory and it should be the responsibility of the
user/administrator to make sure the description field is filled/updated correctly.
Press Continue to create the Secondary MPR DICOM Series or Exit to cancel the process.
The Secondary MPR Series Creation begins processing (see Figure 118).
Once completed, the new DICOM series is immediately added and accessible in DiagNET. It is also
automatically sent to the server for archiving and can be viewed at any time thereafter (see Figure 119).
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Figure 118: Secondary MPR Series Creation Processing
Figure 119: The new series IntelliSpace PACS DCX DiagNET
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18. Image Manipulations

This chapter consists of manipulations performed on the images.
18.1 Lock and Mark

The Lock and Mark feature enables you to quickly lock and mark any images, while browsing through studies.
Images can be locked to ensure that no further changes can accidentally be made. The images can be marked for
various reasons, such as compiling a report of only specific images.
This function is used from within a matrix display for reporting, selecting, or printing images.
The options available through Lock and Mark are shown below:
Mark Enables the selection of either one or more images. The image can be
marked and then viewed separately.
Select Marks only Enables the isolation of a group of only marked images. A new matrix
can be constructed of only the number of marked images.
Release All Marks Enables the release of marks on all images at once.
Select one of the

Mark options
Figure 120: Mark options
To mark an image:
Select Lock and Mark from the right-click menu, as shown in Figure 120.
Once an image is marked, a ‘ ’ sign appears at the top right corner of the screen (see Figure
121).
Re-select Mark to unmark a single image or Release All Marks in order to unmark multiple
marks. Once released, any image manipulations (such as measurements, pan or zoom ) can be
made.
Lock and Mark the image once again to save it with the newest changes.
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Figure 121: Mark sign location
18.2 Lock
The Lock feature enables you to block the ability to manipulate the image properties. This way, image properties
(such as changing the Window Level or Zoom) of all images within a study can be modified, while the properties of
the locked image remain the same.
This option is meant to be used regarding both DICOM print and preparing images for a report. Although, its’ main
use is when using matrixes.
Select one of the

Lock options
Figure 122: Lock options
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In order to lock an image, select it, right click the mouse and choose the Lock and Mark option. The following
possibilities appear (Figure 122):
Lock Allows you to isolate a group of images. Lock the requested images and
build a new matrix according to the number of locked ones. Once an
image is locked, it can serve as a reference to the same image locked in
another position.
Release All Locked Enables you to release the locked images at once.
Once an image is locked a ‘ ’ sign appears at the top right corner (see Figure 123).
In order to release it, either click the ‘ ’ sign or select Release All Locked. It is possible to do all the relevant
actions (such as: pan, zoom, etc.) on a selected image and only then lock it. In this case, the locked image is saved
with the changes done.
Figure 123: Lock sign location
18.3 Link
This option enables to define linking and the exact parameters linked between several stacks.
There are two Link icons:
Screen - Figure 124 - on main toolbar, links all active stacks.
Image - Figure 125 - on image toolbar, links only the selected stack.
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Figure 124: Link icon screen location
Figure 125: Link icon image location
This is performed by the following:
Select the required stacks to be linked to (either all active or selected ones).
Click the icon ( ) in its correct location, according to the choice from previous stage.
Linking enables selected image manipulations, such as: scrolling, zooming, panning etc. to be synchronized
between several stacks. It is possible to perform automatic link, in which the system automatically decides which
images to link according to time and position properties. It is possible to perform manual link in which the images to
be linked is selected manually.
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This icon will be displayed in the top left corner in every linked window.
Using Link option can be reached by using right click mouse on the selected displayed image (see Figure 126).
Figure 126: Link option using right click
It is possible to define Link option as seen in Figure 127 (go to: Options > Preferences > Tools > Link section
IntelliSpace PACS DCX Client screen. This enables a combination of Link option together with the options
selected in (see Figure 127).
Link section
Figure 127: Link definitions window
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Figure 128: Link Presets option
After Link icon is selected, right clicking the mouse enables further options regarding Link presets (Figure 128).
The following choices are presented:
Set All This option selects all available presets.
Clear All This option clears all available presets.
Zoom Select this option to link images according to Zoom function. Whenever
zoom is performed to one image it automatically is performed to all the
linked ones provided this preset is selected.
Window Level Select this option to link images according to Window Level function.
Whenever window level is changed in one image it is also changed in all
the linked images.
Pan Select this option to link images according to Pan function. Whenever
pan is performed on one image it is also performed on all linked images.
Spatial Transform Select this option to link images according to Spatial Transform function
(rotation or flipping). Whenever spatial transform is performed on one
image it is also performed on all linked images.
Navigation Select this option to link images according to Stack Navigation function.
Whenever you navigate in one image you automatically navigate in all
linked images.
Auto Sync Select this option to determine if the linked images are selected
automatically (by the system) otherwise it is selected by the user.
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19. Measurements
This chapter contains different types of image measurements.
There are two Measurement icons:
Screen - Figure 129

Image - Figure 130
Figure 129: Measurement icon screen location
Figure 130: Measurement icon image location
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Click this icon to measure an image. This is done according to the following:
Select the required image to be measured.
Click the icon.

Place the mouse on the part of image to be measured. Click and hold the left button of the mouse
and drag the measurement shape (from the previous stage) to a required place on the image.
The area to be measured is calculated automatically (see Figure 131).
After the measurement is executed it is possible to do the following:
Move the measurement – by dragging it with the mouse to a desired location.
Move the labels’ measurement – by dragging it with the mouse to a requested location.
Figure 131: Measurement example
The default measurement is defined as seen in Figure 132 (go to: Options > Preferences > Main screen >
General section > Default Measurement option in IntelliSpace PACS DCX Client screen). Choose the required
measurement.
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General section
Default Measurement
option
Figure 132: Default Measurement selection
Using Measurements option can be reached by using right click mouse on the selected displayed image (see
Figure 133).
Figure 133: Measurement option via right click
When Measurements icon is active, right clicking the mouse enables to select the requested kinds of
measurements (see Figure 134).
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Figure 134: Measurements right click possibilities
Each possibility seen in Figure 134 is explained in the sections below.
19.1 Linear Measurement (Distance choice)

This option allows measuring a line distance of two selected points
This is done as follows (Figure 135):
Select Distance option using the mouse.

Move the mouse to a chosen location on the image.
Hold the left button of the mouse and place the mouse on the requested source measured point.
Drag the mouse to a desired measurement destination point.
Once leaving the left button the measured distance is displayed (including its calculations).
To exit the Measurement Mode, select an alternate tool.
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Figure 135: Linear Measurement example
19.2 Density Values Measurement (Density choice)

This option allows measuring the density of a chosen point.
Select Density option using the mouse.

Hold the left button of the mouse and place the mouse on the requested measured point on the
image.
Once leaving the left button the measured density is seen (including its calculations).
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Figure 136: Density Measurement example
19.3 Area Measurement (Ellipse, Rectangle, Polygon Choice)

This selection allows measuring the area under an ellipse (Figure 137), rectangle (Figure 138) and polygon
(Figure 139).
To measure both an ellipse and a rectangle do as follows:
Select the required shape using the mouse.

Once leaving the left button the measured area including its minimum calculated intensity point is
displayed.
In order to measure a polygon, do as follows:
Select the required shape using the mouse.

Drag the mouse to a desired polygons’ edge. When you release the left mouse button, the
polygons’ edge is set.
Continue with the polygons’ creation according to the previous stage.
Select Ctrl + click left mouse or press the <ESC> button to end the polygon’s creation and the
measured area including its minimum calculated intensity point is displayed.
Figure 137: Ellipse area measurement example
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Figure 138: Rectangle area measurement example
Figure 139: Polygon area measurement example
19.4 Intersecting Angle Measurement (Angle choice)

This option allows measuring an angle between its openings.
Select Angle option using the mouse.
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Click the mouse once on the desired location until an angle of 90° is displayed.
Hold the left button of the mouse and drag the angles’ lines openings to the desired ones.
Once leaving the left button the measured angle is being shown (including its calculations).
Figure 140: Angle measurement example
19.5 Cobb Angle Measurement (Angle between Lines Choice)

This option allows measuring an angle between defined lines.
Select Angle between Lines option using the mouse.

Click the mouse once on the desired image location until an angle of 0° is displayed.
Hold the left button of the mouse and drag the angle itself to the desired location.
Once leaving the left button the measured angle between the lines is being shown (including its
calculations).
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Figure 141: Angle between lines measurement example
19.6 Text comment Measurement (Callout Choice)

This option allows adding a text callout comment.
This is performed as follows (Figure 142):
Select Callout option using the mouse.

Click the mouse once on the desired image location until a text box is displayed.
Insert the required text. Click OK to confirm. Otherwise, click on Cancel button.
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Figure 142: Callout measurement example
19.7 Pointer Interest Annotation (Arrow Choice)

This option allows arrow pointing.
Select Arrow option using the mouse.

Once leaving the left button the pointed area is displayed.
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Figure 143: Arrow measurement example
19.8 Text Annotation (Text Choice)

This option allows adding text.
Select Text option using the mouse.

Click the mouse once on the desired location on the image until a text box is displayed.
Insert the required text. Click OK for confirmation. Otherwise, click on Cancel button.
Figure 144: Text measurement example
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19.9 Edit Text Annotation

This option allows editing text after inserting it.
Select the text to the image to be edited.

Right-click and select Edit Text.
Edit the required text. Click OK for confirmation. Otherwise, click on Cancel button.
Figure 145: Edit Text Measurement example
19.10 Calibrate
This option enables the calibration of image measurements. This option is available only on non-calibrated images
or on non-calibrated image areas. Note that this option becomes active using Distance option. After the calibration
definition is set, it is used for every kind of selected measurement.
Select Distance choice using the mouse.

Measure the required distance in pixels.
Right-click and select Calibrate. A text box appears (Figure 147).
Edit the required units. Click on OK button for confirmation. Otherwise, click on Cancel button.
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Figure 146: Calibrate option is active
Figure 147: Calibration box example
19.11 Hide
This option hides the entire measurements performed.
Select Hide option using the mouse and all the measurements are hidden (Figure 148).
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Figure 148: Hide Measurements example
19.12 Erase
This option erases a selected measurement.
This is done as follows:
Place the mouse on the object to be deleted and click it.

Select the Erase option using the mouse.
19.13 Erase All

This option erases all the measurements.
Select Erase All option using the mouse and all the measurements are erased.
19.14 Displayed Values for Area Measurement

In cases of Area Measurement (Ellipse in addition to the value given as default (Area), it is possible to add the
values as seen below.
Right-click and select one of the following values to be added: Max Value, Min Value, Mean
Value, Standard Deviation or Set All Statistics option using the mouse.
Choose one of the area measurement possibilities (Ellipse, Rectangle or Polygon).
Select the desired area to be measured.
In order to clear all the displayed values, select Clear All Statistics option using the mouse.
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20. Key Image

This option generates new image manipulations performed on an image or a set of images.
20.1 Save Key Image

It is possible to define a set including all kinds of different operations performed on an image or a set of images and
add it as a new image (it is added as a key image).
Figure 149: Key Image
This is performed according to the following steps:
Select an image to be saved as a key image (make sure it is displayed on the screen)
Perform all desired operations
Click icon and Figure 150 appears
Figure 150: Key Image confirmation
Click on Yes button to add a Key image. This Key Image is added as an image preview on the left side of the
screen (Figure 151). Otherwise, click No button
It is possible to use icon to store in the database images saved as key images.
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Figure 151: Save Key Image icon location
It is possible to add a key image using the right click option; right click the mouse while placing it on the selected
image, and select Add Key Image (Figure 152):
Figure 152: Add Key Image via right click
TIME SAVER: To add key images without having to confirm each one: Go to:
Options > Preferences > Main screen > General section > Prompt confirmation
before adding of key images option in IntelliSpace PACS DCX Client window ( see
Figure 153) and uncheck this option. You no longer need to confirm each key image
as in Figure 150.
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Figure 153: Prompt confirmation before adding of key image option
20.2 Remove Key Image

It is possible to remove an existing key image previously added by doing as follows:
Right click the mouse while placing it on the selected image

Select Remove key image (Figure 154)
After choosing Remove key image option, Figure 155 appears.
Figure 154: Remove Key Image selection
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Figure 155: Remove key image Error message
Note that if a Key Image is saved, it cannot be deleted.
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21. Hanging Protocol

This option defines how the studies appear by default in the DiagNET. Configure Hanging Protocols in the
IntelliSpace PACS DCX Client as follows: go to: Options > Preferences > User Preferences > Hanging
Protocol section (Figure 156). This screenshot shows a list of Hanging Protocols (refer to IntelliSpace PACS DCX
Viewer User manual for further explanations). Note that by default the first protocol is being viewed.
A list of Hanging
Protocols is seen
here
Figure 156: Hanging Protocol screen
Figure 157 emphasizes that the hanging protocol is applied automatically and the defined matrix is displayed (in
this example, a 1x2 matrix with side-by-side view).
Figure 157: Hanging Protocol example
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21.1 Hanging Protocol Selection

It is possible to select a specific Hanging Protocol by using the following ways:
Click the arrow next to the Hanging Protocol button and a drop-down list of set protocols are
shown (Figure 158 for example). Choose the required hanging protocol.
Click on F11 key on the keyboard to move to the next hanging protocol.
Click on F12 key on the keyboard to reach the previous hanging protocol.
Click this
arrow A list of all
defined
Hanging
Protocols is
seen in this
drop down
list. The
current one
has a ‘√’ sign
near it.
Figure 158: Hanging Protocol selection option
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22. IntelliSpace PACS DCX DICOM Printing

DICOM Images are printed from the following IntelliSpace PACS DCX applications:
 DiagNET: A single page containing DICOM images is printed directly to film using DICOM Direct Print or
alternatively printed to paper through a PC printer
 Print Composer: Multiple pages containing DICOM images are previewed, manipulated and printed to a
DICOM printer
23. Printing Images from DiagNET

DiagNET provides the following printing workflows:
 Printing via Direct DICOM Print
 Printing to a PC Printer
23.1 Printing via Direct DICOM Print

The Direct DICOM Print workflow enables printing images to a DICOM Printer directly from DiagNET. A print dialog
is not displayed. Rather, the page is immediately sent to the station’s default printer.
This section describes how to:
 Set the default DICOM Printer Settings for the station

 Create the layout and print the required images
23.1.1 Setting the Default DICOM Printer Settings for the Station
A default DICOM Printer and template must set for the station and applies to all the users printing from the station..
To set a default printer and template for the station:
From IntelliSpace PACS DCX Client menu bar select Options > Preferences.
In the Station Settings tab, select Printer Settings.
In the Default Printer Settings, choose the printer and template
The remaining fields are added automatically based on the settings predefined by the administrator.
Click OK to save the selected printer settings.
The following PACS Viewer message opens: “You should log off and log on again to apply setting
changes”.
Click OK.
Click the on the Toolbar to log off for the new settings to take effect.
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Figure 159: Printing Preferences Page
NOTE: A temporary default printer cannot be set for a single session. However, one can easily
set the default printer and then change it once the session is complete.
If no DICOM print settings are displayed, contact the system administrator.
23.1.2 Creating the Layout and Printing

Direct DICOM Print enables the user to print the layout as it is displayed in DiagNET to a pre-configured DICOM
Printer. The printed images include the matrix or grid layout, patient information and any image annotations and
manipulations.
When printing images using Direct DICOM Print:
 All screen specific information, such as the zoom factor or window level, are not printed on the images since
factors may change once printed on film.
 Reference lines are displayed on images printed through the Direct DICOM Print workflow but are not
displayed when printing from Print Composer.
 True Size printing is only available through the Print Composer.
 If images from different studies or series are printed on one film, “Multi Study” or “Multi Series” is printed in
place of study information (e.g. Accession Number, Study Date, etc…). However, annotations on patient
level will always be printed. This practice ensures that a mismatch between images and on-film annotations
never occurs.
WARNING: For safety purposes, image specific annotations that appear on pages with
images from different studies are replaced by multi study annotations.
To print an image directly to a DICOM printer:
Do one of the following:
 Click the icon on the Toolbar to open the DICOM Print drop-down menu and select Print
Screen (see Figure 160).
NOTE: The icon can be selected to repeat the last print selection. Meaning, if Print
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Screen is selected, the DICOM Print icon will print the screen again.
 Right-click on the selected image > select DICOM Print> select Print Screen.
 Press Ctrl+P (shortcut keys).
NOTE: It is possible to set user specific keyboard shortcuts through the user preferences (see
Adding Images from Pre-Configured Shortcut Keys).
The image is sent to the print spooler (IntelliSpace PACS DCX Client Service) and printed.
NOTE: The Print Spooler (MDC Client Service) is an autonomous system tray application that
notifies the user on any status updates, such as pending print jobs, print errors or job
completion. As a separate application, the MDC Client Service can continue to handle all print
jobs even if the DiagNET or the IntelliSpace PACS DCX Client is closed.
Figure 160: DICOM Print icon
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23.2 Printing to a PC Printer

The Print feature enables printing selected images on a PC printer. Images printed from DiagNET are printed
exactly as they appear (i.e. annotations and DICOM information will be printed on the image if they exist).
Figure 161: Print Icon
To print the images exactly as they appear in DiagNET:
Click the icon in the image Toolbar (see Figure 161).

The print dialog window is shown.
Figure 162: Print dialog
NOTE: When printing images from DiagNET, print properties, other than the Number of
copies, are inactive through the Print dialog window.
Click OK.
The image is printed (see Figure 164).
NOTE: On image information can be added or removed by selecting the icon before
printing the image (see Figure 163).
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Figure 163: On-image information on/off icon
Figure 164: Example of a printed image without DICOM information
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24. Print Composer DICOM Print

This chapter describes how to add DICOM images from DiagNET and organize, preview and print multiple DICOM
Images from Print Composer.
24.1 Print Composer Features

The IntelliSpace PACS DCX DICOM Print Composer module provides fast, intuitive, WYSIWYG DICOM printing.
Print Composer comprises the following features:
 WYSIWYG
Print Composer includes a WYSIWYG (What You See is What You Get) feature that ensures that the
images displayed in Print Preview are not affected by the screen resolution. The images displayed in Print
Preview are identical to the images printed on film.
 Matrix and Grid (Custom Formats) Page Layout Options
Images can be arranged on a page in Page Preview using a standard matrix for identical sized images or
alternatively by selecting a predefined grid for different sized images.
 Image Manipulation Tools
The zoom, window level and tools are embedded in Page Preview area and provide fine tune of the images
before sending the images to print.
 Customizable Headers, Footers and Logo
Predefined customized headers, footers and logo can be added to the printed pages.
 True Size Printing
24.2 Print Composer GUI Overview

The following figure displays the Print Composer window components.
Toolbar
Page
Preview
Thumbnail
Panel
Page List
Figure 165: Print Composer Window Components
The table describes the Print Composer window components:

Component Description
Toolbar Contains the page layout, printer and template settings
Thumbnail Displays the images added from DiagNET according to the area of interest
Page Preview Displays the active page
Page List Displays the pages to be printed
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24.3 Print Composer On-Image State Tags

Print Composer adds a set of preconfigured on-image tags that are displayed on the image in Page Preview and
are printed to film. These tags indicate the image status, for example: zoomed, true size or sharpened.
The following figure displays the Print Composer on-image tags.
Figure 166: Example of On-Image image state tags
The following table describes the Print Composer on-image state tags:
On-Image Tag Description

DICOM Information displayed on the margins of the image according to Print
Patient Information Composer’s best fit feature. This data is configurable in the Administration
Utility and can be removed.
Orientation markers
Automatically added to the image from the modality and cannot be removed.
(L, R, A, P)
Indicates that the image is set to be printed as true size. For more information,
True Size
see the True Size Printing section.
Indicates that the image is zoomed. All the non- true sized images receive the
Zoomed
Zoom tag.
Sharpening Indicates that the image was sharpened in DiagNET.
Lossy Indicates that the image was defined as Lossy in DiagNET.
Bit Depth Reduce Indicates that a grayscale image is printed in color causing the bit depth to be
xx->8 reduced from xx to 8.
Displays the measurements created in DiagNET
Measurements To remove the measurements from the printed images, return to DiagNET and
delete the measurements.
WARNING: When printing to a color printer, the grayscale images may suffer quality
degradation to bit depth 8.
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WARNING: Grayscale images with a bit depth of 13 and above, are automatically reduced
to a bit depth of 12, which may result in quality degradation.
24.4 Workflow
The Print Composer workflow comprises the following procedures:
Adding Images Laying out/ Performing Selecting Printer

Printing the
from DiagNET to Organizing Image and Template
Images to Film
Print Composer Images Manipulation Settingss
Figure 167 Print Composer Workflow
The following sections describe the Print Composer workflow related procedures.
24.5 Adding Images from DiagNET to Print Composer

The DICOM Print option in DiagNET launches Print Composer. The following sections describe the different ways to
add an image, a range of images or a stack to Printer Composer from DiagNET.
Prerequisite
To access Print Composer, at least one printer type and template are required to be configured on the system.
NOTE: If the “No Printers are defined” message is displayed when selecting the DICOM Print
icon in DiagNET, contact your System Administrator.
NOTE: The internal matrix layout defined in DiagNET is maintained when adding images to
Print Composer and is displayed as a single page.
24.5.1 Adding a Single Image

The Add Image option adds only the selected image in DiagNET to the Thumbnail Panel in the Print Composer.
To add a single image to Print Composer:
Right-click in DiagNET on the image you want to add to the Print Composer.
 Select DICOM Print from the right-click menu > then select Add Image (see Figure 154).
 Select Add Image from the DICOM Print icon drop-down menu on the Toolbar (see Figure
169).
 Click the Space bar. Adding images can be added with a shortcut. The default shortcut key is
Space bar. For more instructions on how to modify the shortcut keys refer to Adding Images
from Pre-Configured Shortcut Keys
The image is added to the Thumbnail Preview Panel in the Print Composer.
Figure 168 Add Image from Right-click Menu
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Figure 169: Add Image from DICOM Print Icon Drop-Down Menu on the Toolbar
24.5.2 Adding a Page

The Add Page option adds the images displayed on the current page layout in DiagNET to the Print Composer. The
images are added to the Thumbnail Panel and onto a page in the Page List.
To add a page to Print Composer:
Right-click in DiagNET on any image.

 Select DICOM Print from the right-click pop-up menu > then select Add Page (see Figure 170).
OR
 Select Add Page from the DICOM Print icon drop-down menu (see Figure 171 ).
The page is added to the Thumbnail Preview Panel, the Page List, and the Page Preview in the Print
Composer.
Figure 170: Add Page from Right-Click Menu
Figure 171: Add Page from Toolbar Icon Drop-Down Menu
NOTE: When pages are added with more than one image from a series, although the page
appears in the Print Composer as it appeared in DiagNET, each of the individual images is
added to the Thumbnail Panel.
NOTE: Adding pages can be added with a shortcut key as well. The default shortcut key is
Alt+P. For more instructions on how to modify the shortcut keys see Adding Images from Pre-
Configured Shortcut Keys.
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24.5.3 Adding a Range of Images

The Add Range option adds a portion of images (with possible internal skips) from a full series or a stack to the
Print Composer. The images appear in the Thumbnail Panel in the same sequential order as in the series in
DiagNET.
To add a range of images to Print Composer:
Right-click the image you want to add to the Print Composer from DiagNET.
 Select DICOM Print from the right-click menu > then select Add Range > Add Range (see Figure
172).
 Select Add Range > Add Range from the DICOM Print icon drop-down menu (see Figure 173).
 Use the default Ctrl+R shortcut.
Figure 172: Add Range from Right-Click Menu
Figure 173: Add Range from Toolbar Icon Drop-Down Menu
TIME SAVER
To add a specific range of images without having to manually enter in the data:
Select: Add Range > Mark First.
Mark First enables DiagNET to remember the image that should appear in the Begin from:
field of the collecting images window.
Figure 174: Mark First Selection
Scroll to the image that should appear in the End on: field of the collecting images window.
Select: Add Range > Add Range.
The Collecting image window is shown with the marked images in the Begin from: and End on:
fields selected.
Click Continue. The range of images is added to the Print Composer.
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The Collecting images dialog opens.
Figure 175: Collecting images dialog
Click Continue to add the selected images to the Print Composer.
NOTE: The add range feature automatically populates the Begin from: with the first image and
End on: with the image currently viewed. In the currently viewed image 13 is what automatically
appears in the End on: field.
NOTE: The number inserted into the Skip field specifies the number of images that will be
“skipped” between each consecutive image that will be sent to the Print Composer. (i.e. as
shown in , the number next to the Skip field show that within the range of 1-13, since 3 slides are
to be skipped, slides 1, 5, 9, and 13 will be printed.)
24.5.4 Adding a Stack of Images

The Add Stack option adds all images within a stack/series to Print Composer.
To add a stack of images to Print Composer:
Right-click in DiagNET on the image you want to add to the Print Composer.
 Select DICOM Print from the right-click pop-up menu > then select Add Stack (see Figure
176).
 Select Add Stack from the DICOM Print icon drop-down menu (see Figure 177).
 Use the default shortcut key is Ctrl+Space. For more instructions on how to modify the shortcut
keys, see Adding Images from Pre-Configured Shortcut Keys.
The images are added to the Thumbnail Preview Panel in the Print Composer.
Figure 176: Add Stack from Right-Click Menu
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Figure 177: Add Stack from Toolbar Icon Drop-Down Menu
24.5.5 Adding Images from Pre-Configured Shortcut Keys

It is possible to perform all add image operations through shortcut keys. The IntelliSpace PACS DCX Client is
installed with the following pre-configured shortcut keys:
Adding Images Default Shortcut Keys

Add image shortcut key: Space
Add range of images shortcut key:
Mark First: Ctrl+E
Add Range: Ctrl+R
Show Composer shortcut key: Ctrl+H
Add page shortcut key: Alt+P
Add stack(series) shortcut key: Ctrl+Space
Print screen shortcut key: Ctrl+P
The pre-configured shortcut keys can be modified per user through the user preferences.
To create your own shortcut keys:
Select Options from the menu bar in the IntelliSpace PACS DCX Client.
Select Preferences.
In the User Preferences tab, in the Preferences tree, select DICOM Printer Settings.
In the relevant shortcut field, type a new shortcut combination on the keyboard.
The shortcut is automatically added to the field.
Click Apply to apply the settings.
Click OK to save the selected shortcut keys.
Log out from the IntelliSpace PACS DCX client for the settings to take effect
Figure 178: Print Composing Default Settings
Page | 128
24.5.6 Accessing Print Composer from IntelliSpace Applications

Once Print Composer is launched, the Print Composer icon is displayed on the Windows taskbar and the Print
Composer option is added to the DICOM Print drop-down list in DiagNET.
To access Print Composer, do one of the following:
 Select the Print Composer icon on the Windows Taskbar (see Figure 179).
Figure 179: Print Composer Taskbar Icon
Note: If the Windows taskbar is hidden, press the Window key on your keyboard to display the
taskbar.
 Right-click any image in DiagNET and select DICOM Print > Show Composer (see Figure 180).
Figure 180: Show Composer Option using the Right-click Menu
 Press the shortcut keys Ctrl+H (default).
NOTE: The shortcut keys can be modified at any point. For a further explanation on
modifying shortcut keys, see Adding Images from Pre-Configured Shortcut Keys.
Page | 129
24.5.7 Exiting Print Composer

Images are not saved in Print Composer when closing the application. Therefore verify that the required images are
printed prior to exiting the application.
To exit Print Composer:
Click X in the upper right corner of Print Composer.
The Close Composer confirmation message opens (see Figure 181).
Click Yes.
Print Composer closes and the images including the layouts and the image manipulations are not
saved..
Figure 181 Closing Composer Confirmation Message
24.6 Laying Out and Organizing Images in Page Preview

Page Preview in Print Composer displays the images of the current active page. Printing multiple images on a page
requires setting the page layout according the number of images to appear on the page.
Print Composer provides the following two modes for laying out images:
 The Matrix Used for printing an even number of identical sized images on a page
 The Grid (Custom Formats): Used for printing uneven sized images on a page. For example: When printing
a key image with a number of supported images
The following diagram displays the page layout workflow:
Figure 169 Page Layout Workflow
24.6.1 Adding/Removing Pages to the Page Preview Area

The Page Preview area in Print Composer displays the images on the selected active page. Pages can be both
added and removed in the Print Composer.
To add or remove pages:
Click the icon to add a new page to the Print Composer (see Figure 182).
Click the icon to remove the active page from the Print Composer (see Figure 182).
OR
Click the icon to delete the active page from the Page Preview and the Page List (see Figure 183).
Page | 130
Figure 182: Adding and Removing Pages
Figure 183: Image Remove Page Icon
NOTE: New pages are always added at the end of the Page Preview. However, any individual
page can be deleted by first selecting it before clicking the icon to remove the page.
All pages added, appear in the Page List in the page list along the bottom of the screen. The page, currently
selected, is what appears in the Page Preview.
Figure 184: Page List
24.6.2 Selecting the Matrix Layout Mode

The matrix page layout supports viewing and printing identically sized cells on a page (see Figure 185). The
selected page Matrix applies to the active page in Page Preview and serves as the current layout mode until
modified by the user or once Print Composer is closed.
To set the page matrix:
 Click the arrow to access the page matrix window.

 Select the square that would represent the bottom right hand section of the page by moving the
cursor onto that space. For example, the table in Figure 185 would represent 2 rows with 2
columns.
Page | 131
Figure 185: Selecting the Matrix Layout
To set the default Composer matrix:

 Select Options from the menu bar in the IntelliSpace PACS DCX Client.
 Select Preferences.
 In the User Preferences tab, in the Preferences tree, select Print Composing Default Setting.
 In the Default Composer Matrix field, set the number of rows and columns.
 Click OK. The default matrix is set for Composer.
Figure 186 Setting the Default Print Composer Matrix
Page | 132
24.6.3 Selecting the Grid (Custom Formats) Page Layout Mode

The grid (custom formats) page layout supports printing different sized cells (see Figure 187). The grid drop-down
list provides a set of built-in predefined grids.
Figure 187: Selecting a Grid Template
To select a predefined grid template:
 Click on the Toolbar and select a predefined grid from the grid drop-down list.
 Select the template by moving the cursor onto that space. For example, the table in Figure 187
would represent 1 large sized Image with 7 equally sized small images.
24.6.4 Arranging the Images in the Page Preview

Once the page layout, either matrix or grid has been selected, proceed to arrange the images on the page. The
image added to Page Preview is marked with a small circle at the bottom left side of the image in the Thumbnail
Panel (see Figure 188).
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Figure 188: Circle Icon added to Image in the Thumbnail Preview Panel
The following sections comprise of the following procedures:

 Manually Arranging the Images on the Pages
 Automatically Arranging the Images on the Pages
24.6.4.1 Manually Arranging the Images on the Pages

To add an image to one of the pages:
Select the page in which you want to add the image by clicking the page in the Page List. The page
appears in the Page Preview.
Drag the image from the Thumbnail Panel into the Page Preview.
The Page Preview displays the page with the selected image.
Images can also be manually removed from the pages, regardless of the layout selected.
To remove one of the images from one of the pages in Page Preview:
In Page Preview, select the icon on the image to be removed.

The image is removed from the Print Preview and Page List but is not deleted from the Thumbnail
Panel.
Figure 189: Removing an Image from Page Preview
Page | 134
24.6.5 Automatically Arranging the Images on the Pages

The Auto Arrange feature provides automatic layout of all the images from the Thumbnail Panel to the Page
Preview, according to the defined matrix or grid.
The Auto Arrange feature is handy in the case that many images were added to the Print Composer and manual
layout would be tedious.
NOTE: When using Auto Arrange, all pages already laid out will be cleared.
To use the Auto Arrange feature:
 Set the preferred matrix or grid layout to be used in all pages for Auto Arrange.
 Click the icon.

The following message is displayed.
 Click Yes.
The images in Page Preview and all the pages in the Page List are removed and the new images are
automatically arranged according to the currently defined Page Matrix or Grid layout.
Page | 135
24.7 Performing Image Manipulation in Page Preview

Print Composer’s image manipulation tools in the Page Preview provide additional fine tune of the images before
sending the images to print.
The imaging tools include:
 Zoom
 Pan
 Window Width/Level Control Window
24.7.1 Accessing the Image Manipulation Tools

Print Composer provides three different ways to access and activate the manipulation tools in Page Preview.
To access the image manipulation tools:
 Do one of the following:

 Click on the image manipulation icon on the Toolbar to run the image manipulation on all the
images on the selected page.
 Right-click anywhere on the displayed image in the Page Preview area and select Tools.
 Use the predefined mouse +keyboard shortcut combination:

The following table summarizes the image manipulation tool mouse and keyboard shortcut
combinations:
Tool\Action Mouse + Keyboard Shortcut Combinations
Zoom  Press mouse wheel + right button

 Ctrl + scroll mouse wheel (Same as DiagNET)
Pan  Press mouse left button + mouse wheel
Window Width/ Level Control  Press mouse wheel
Selecting a single image  Ctrl + left mouse button
Selecting a range of images  Shift + left
The tools drop-down list opens.
Page | 136
Figure 190 Selecting an imaging tool from the Toolbar
Figure 191 Right-click on a Single Image in Page Preview to Access Imaging Tools
24.7.2 Zoom
Use the zoom tool to zoom in and zoom out of the images in Page Preview. The zoomed image is printed exactly as
it appears in Page Preview and an on-image tag is added to the image.
Note: If an image is selected for true size printing, the zoom option is disabled.
Page | 137
To zoom in\ zoom out of the image:

 Right-click anywhere on the displayed image in Page Preview and select Tools > Zoom.
 Activate Zoom using the mouse, press and hold the mouse wheel button and right button.
 Click and hold down the left button of the mouse and do one of the following:
 Drag the mouse upwards to zoom in the image (see Figure 192).
 Drag the mouse downwards to zoom out the image (see Figure 193).
Figure 192: Zoom In Image in Page Preview
Figure 193: Zoom Out Image in Page Preview
Page | 138
24.7.3 Pan
Use the Pan tool to move the image in Page Preview within the cell.
To move an image using pan:
 Select the required image in the Page Preview area.

 Do one of the following:
 Access pan from the on-image menu:
1. Right-click anywhereon the displayed image in the Print Preview area and select
Tools > Pan.
2. Click and hold the left button of the mouse.
 To activate pan using mouse, press and hold the left button and then press the mouse
wheel.
 Drag the mouse to a desired location. The image moves in the same direction as the mouse
(see Figure 194).
Figure 194: Example of Moving an Image using Pan
24.7.4 Window Width/Level Control

Use the Window Width/Level Control tool to adjust the image contrast or brightness.
To adjust the image contrast or brightness:
Select the required image in the Page Preview area.

Do one of the following to access the Window Width/Level Control tool:
 Access Window Width/Level from the on-image menu:
1. Right-click anywhere on the displayed image in the Print Preview area and
select Window Level.
2. Click and hold the left mouse button.
 To activate window level using the mouse, press and hold the mouse wheel.
 Right-click anywhere on the displayed image in the Print Preview area and select
Window Level.
Click and hold the left button of the mouse and perform one of the following:
 To darken the image: Drag the mouse downwards (see Figure 195).
 To brighen the image: Drag the mouse upwards (see Figure 196).
 Press and hold the left mouse button over the image: Drag the mouse left/right – the
width of the image LUT changes. Drag the mouse up/down – the center of the image LUT
changes.
Page | 139
Figure 195: Darkening the Image
Figure 196: Brightening the Image
24.7.5 Selecting Images using the Pointer

The Pointer selects an image or images in the Page Preview area.
To select an image or a range of images:
To select a single image,do one of the following:

 Select an image in the Page Preview area and right-click anywhere on the
displayed image and select Tools > Pointer.
 Press Ctrl + left mouse button.
To select a range of images:

 Press Shift + left mouse button and select the first and last image.
The entire range is selected and linked.
Page | 140
Figure 197: Selecting an Image using the Pointer tool in Page Preview
24.7.6 Linking Images

Use the link tool to perform group a number of images. Once the images are linked, proceed to perform image
manipulation on multiple images simultaneously. The linked images are displayed with a light blue border.
To link all the images on the current page in Page Preview:
Click the Link icon on the Toolbar.

All the images in Page Preview are linked and have a light blue border..
Click any of the image processing tools and apply to the images on the page.
Figure 198: Linking the images in the Page Preview
Page | 141
To link/unlink individual images on different pages:
Select the first image in the Page Preview area.

Right-click anywhere on the displayed image in the Print Preview area and select Link.
Link additional images by repeating the previous steps for each image.
The images are grouped.
To unlink an image from a group, select the highlighted Link tool icon on the Toolbar.
Proceed to perform an image manipulation action on all the linked images.
Figure 199: Linking Individual Images in Page Preview
24.7.7 Reset
The Reset option reverts the selected image back to its original state when copied from DiagNet.
To reset the image:
Select an image or multiple images in the Page Preview area.

Click the Reset icon on the Toolbar.
The images are reverted to their original state.
Page | 142
Figure 200: Resetting an Image in Page Preview
24.8 Selecting Printer and Template Settings

24.8.1 Printer Settings Toolbar
The settings are used for adjusting the composed pages to your specific printer, film and colour
requirements. Print Composer automatically adjusts and displays the images in the Page Preview area
according to the printer settings selected from the Toolbar. These composed pages can then be sent to
print and will be printed exactly as displayed on screen.
Figure 201: Printing Related Settings on the Toolbar
Page | 143
The following table describes the printing settings:
Settings Description
Printer The Printer drop-down menu displays all the available printers. The printers
that appear in the Printer menu on the Toolbar have been pre-configured in
the PACS.
NOTE: The default DICOM Printer is set in the Printer

Settings of the IntelliSpace PACS DCX client.
For more information on how to set the default printer, see
Setting the Default DICOM Printer Settings for the Station.
Template The Template drop-down menu displays all the available printing
settings. These include annotations, calibrations, borders and empty
image colours and other settings that are not represented in Print
Composer.
NOTE: The system administrator configures the templates in

the Administration Utility. These predefined templates are
then displayed in the Template drop-down menu.
Medium Type The medium type defines the type of film required for printing.
Medium Size The medium size defines the required film size.
Orientation Orientation defines the film orientation which could be either Portrait or
Landscape.
Color Mode The color mode configuration enables printing colored images in
grayscale, color or Auto mode.
Auto Mode: automatically adjusts all the images on all the pages to
color or greyscale depending on the type of images on the page.
NOTE: Printing grayscale images in color can reduce the

quality of the image.
Number of Copies The number of copies required for printing.
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24.8.2 True Size Printing

Images can be printed in true size through the Print Composer. Images printed in true-size are accurately measured
to a true scale of the patient. In reality, 1cm on the printout corresponds to 1cm on the human body.
Guidelines and Limitations for True Size Printing:
 The True Size Printing checkbox is disabled and cannot be selected, when the printer, resolution or film
size were not calibrated. To correct this, contact the System Administrator.
 Not all images are supported to be printed in true size. It is dependent on the DICOM tags received from the
modalities.
 An image that has been configured as true size cannot be zoomed.
WARNING: Before printing an image in true size, the printer, pixel size, template,
resolution and printable area settings must be configured correctly and the
printer is required to be calibrated by the system administrator.
To print true size DICOM images:
Mark the checkbox next to True Size Printing in the Printer Settings of the Print Composer.
The TRUE SIZE tag is added to the image in Page Preview and is printed on film.
NOTE: If the True Size Printing Checkbox is disabled and cannot be selected, the specific
printer or medium size was not calibrated. To correct this, contact the System
Administrator.
NOTE: Not all images can be printed in True Size. If the images do not contain the relevant
tags, a message will be shown when the print is attempted in True Size.
Figure 202: True Size Printing Checkbox
Figure 203 True Size Tag added to Viewed and Printed Image
Click the icon. The images are printed in true size on the DICOM Printer.
Page | 145
24.8.3 Showing\Hiding DICOM On-Image Information

DICOM On-image information is patient related information that is displayed on the margins of the image.
To show\hide DICOM print information:
From the Toolbar, click Pint DICOM Information.
The “Images will be printed without DICOM information” message is displayed.
The DICOM Information is removed from all the pages in Print Preview and is not printed on film.
Figure 204: Showing\Hiding DICOM Print Information
24.8.4 Printing the Images from Print Composer

Print Composer prints all the images that are displayed in the Page List.
Images can be printed with or without DICOM information. Click the grey icon to print images with DICOM
information or the orange icon to print images without DICOM information.
To print the images in the Print Composer:
Click the icon in the Toolbar to print according to the pre-configured printer settings.
Images on each of the composed pages are printed.
Page | 146
25. Advanced Tools

This chapter describes DiagNET advanced visualization tools.
Click this icon (see Figure 205) to use PET/CT Fusion, 3D Viewer or any other available 3rd-Party advanced
visualization tool.
Figure 205: Advanced Tools icon location
Select one of the following options from the drop-down list:
3D Viewer Refer to 3D Viewer user manual

Fusion Refer to Fusion user manual
Page | 147
26. Attachments
This chapter deals with different attachments.
Figure 206: Open Attachments button
Clicking this icon (see Figure 206) causes Figure 207 to be seen. The explanations are provided according to their
alphabetic order.
b
c
Figure 207: Open Attachments screenshot
Page | 148
A View button: views the selected attached file.
B Add button: adds another attachment to the Attachments List. Clicking it displays
Figure 208. Select the requested file and click the Open button. Make sure the file is
actually attached.
C Delete button: deletes the selected file (Figure 209 - Figure 210).
D Update button: causes an attachment to be updated online, according to the

following:
 Select the attachment to be updated
 Update it
 Click the Update button (Figure 211 is seen).
View the attachment (by clicking the View button). Make sure the updating procedure
has been successful. If no updates are done, Figure 212 is displayed.
Figure 208: File to be attached screenshot
Figure 209: Delete message
Figure 210: Deleting Attachment confirmation
Page | 149
Figure 211: After clicking the Update button window
Figure 212: Attachment update not done message
Page | 150
27. Exporting Files

This chapter describes the various imagery file formats that can be exported from DiagNET.
27.1 Exporting AVI files

The Export to AVI feature enables you to export an image to an AVI file format. Therefore, if there are many frames
within the image that can be viewed in sync, exporting it as an AVI file enables you to capture the entire series.
Figure 213: Export to AVI icon location
To export to an AVI file:
Click the icon in the image you wish to export.

The Export to AVI settings are displayed. (see Figure 214)
The table below provides explanations according to the sequential order in which they appear in the Export to AVI
settings page:
1 Path: Shows the path of the files to be exported.
2 Quality: Allows you to change the files' quality. Move the mouse along the bar to
select Low, Medium or High image quality.
3 Lossless: Click this button to select lossy or lossless formatting.
4 Frames per second: Allows you to change the number of frames per second.
Page | 151
2
3
Figure 214: Export to AVI screenshot
Click Ok to confirm the specified settings.

NOTE: The default directory of where all exports should be saved can be defined in the Administration
Utility tool.
NOTE: When exporting multi-dimensional grouped images in a matrix larger than 1x1, the Export to AVI
tool creates separate files for all the visible phases. The name of each file will be extended by a
suffix with the following format “<file name>.p(<phase number>). AVI.
To change the Default for Export location:
 Go to: Options > Preferences > Station settings > Default directory for export of Cine option in PACS
Client screen. In this field insert the full path (see Figure 215).
Figure 215: Default directory for export of cine selection
Page | 152
27.2 Exporting BMP/JPEG Files

The Export to BMP/JPG feature enables you to export images to a BMP or JPEG file.
Figure 216: Export to BMP/JPG icon location
To export to a BMP/JPG file:
Click the icon to in the image you wish to export.

The Export to BMP/JPG settings are displayed. (see Figure 217)
The table below provides explanations according to the sequential order in which they appear in the Export to
BMP/JPG settings page:
1 Path: Shows the path of the files to be exported.
2 Settings: Allows you to choose between a BMP or a JPEG file.
3 Grayscale: Allows you to save the image as a greyscale image.
4 Quality: Allows you to change the files' quality. Move the mouse along the bar to
select Low, Medium or High quality.
5 Lossless: Click this button to select lossy or lossless.
Page | 153
3
4
5
Figure 217: Export to BMP/JPEG window
Click Ok to confirm the specified settings.
NOTE: The default directory of where all exports should be saved can be defined in the Administration
Utility tool.
To change the default for export location:
Go to: Options > Preferences > Station settings > Default directory for export of Single Image / Frame option
in PACS Client screen. In this field insert the full path (see Figure 218).
Figure 218: Default directory for export of single image / frame selection
Page | 154
28. Troubleshooting
28.1 Running Movie Image Problem
Problem: The loaded movie image does not stop running. How can I stop it?
Solution: Click on the upper left button of the image scrollbar (see Figure 219).
Figure 219: Stop running movie
28.2 Sorting Problem

Problem: The images are not sorted although sorting icons were used. What is wrong?
Solution: Choose one of the following possibilities:
Ascending order sorting

Click to sort the images in ascending order. Note that once this
icon becomes active, icon appears. Clicking it once again,

returns the sorting to descending order, and the icon returns to its
original appearance.
Descending order
sorting Click to sort the images in descending order. Note that once
this icon becomes active, icon appears. Clicking it once again,

returns the sorting to ascending order, and the icon returns to its
original appearance.
Page | 155
28.3 Measurement Problem

Problem: Clicking on Measurement icon causes the measurement to be done in a circle shape. How can this be
changed?
Solution: Choose one of the following possibilities:
Click Measurement icon and right-click while placing it on the image. Select the required
measurement (see Figure 220).
Go to the PACS Client. Select the following: Options > Preferences > Diagnostic Preferences
> Main screen. In the Default Measurement field, open the drop-down list (see Figure 221) and
select the requested measurement shape. The chosen shape will be set as default, unless you
change it again.
Right clicking the

image causes this list
to appear
Figure 220: Changing measurement – option number 1
Default
Measurement field
Figure 221: Changing measurement – option number 2
Page | 156
28.4 “Patient has Discrepancies” Warning in the Patient Worklist

Problem: “The Patient has Discrepancies” warning message opens when accessing a patient in the PACS Viewer
or navigating to a patient in DiagNET.
Solution: Do one of the following:
 In a PACS worklist environment, if you have administrator rights return to the PACS Client worklist and
resolve the discrepancy using the Quality Management Suite resolution tool or contact the PACS
administrator. For more information on the resolving discrepancies, refer to the IntelliSpace PACS DCX
User Guide.
 In a RIS worklist environment inform the RIS administrator.
WARNING: Refraining from resolving a discrepancy in the Patient Worklist may compromise
patient information and might lead to incorrect diagnosis.
WARNING: The RIS administrator is required to provide adequate training on accessing the
Viewer from the RIS.
29. Accessing the PACS Viewer from the RIS Worklist

The PACS Viewer is accessible from the RIS worklist in your organization through the Desktop Integration module.
To verify if this option is supported in your site, contact your PACS administrator.
In this scenario, patient data is accessed and retrieved through the RIS worklist and not via the PACS Client
worklist.
WARNING: The RIS administrator is required to provide adequate training on accessing the
Viewer from the RIS.
Page | 157
30. DiagNETBase.INI Configuration File Settings

The DiagNETBase.INI file contains DiagNET default station settings.
This file can be modified using a text editor and is located under the following path on your local station:
\CDP5000 PACS Viewer\Viewer\DiagNETBase.ini.
NOTE: The PACS Viewer (DiagNET) is required to be closed when editing this file.
The following table describes the DiagNETBase.ini file parameters.
Parameter Description
[GUI CONFIG] Sets the following GUI behaviour settings in

DiagNET.
;StudiesPanelHideLeftBound = -45 DO NOT CHANGE!
;StudiesPanelHideRightBound = 20 DO NOT CHANGE!
;StudiesPanelHideDelay = 400 DO NOT CHANGE!
BlockWheelNavigationThroughStudy= CT\MR Prevents wheel navigation between studies for

specified study types.
EnableInfoPanelPinInMultiMonitorMode= 1
Enables the pin panel option in multi-monitor
mode.
Supported values:
 0: Disables pin
 1: Enables pin
[MAIN TOOLS] Sets the image manipulation keyboard shortcuts.
ZoomShortCut = Ctrl+Z
VoiShortCut = Ctrl+S
PanShortCut = Ctrl+X
NavigationShortCut= Ctrl+A For more information on image manipulation tools,

refer to the “Image Processing Tools” section.
[EXPORT JPEG SERIES] Exports JPEG series using the resolution defined
in the DICOM tags.
UseDicomResolution= 0 Supported values:

MinSize= 512
 0: Hides value
 1: Displays value
Sets the JPEG image minimum size.
Default: 512
Page | 158
Parameter Description
[MEASUREMENT STATISTICS] Displays/hides measurement statistics on the

measurement labels.
Min = 0 Supported values:
Max = 0
 0: Hides value
Mean = 1  1: Displays value
StdDev= 1
[MULTI-DIMENSIONAL] Automatically groups multi-dimensional stacks.
InitStateGrouped = 0 Supported values:

;0 - default value  0: Ungrouped (Default)
 1: Grouped
For more information, refer to Setting the Multi-
Dimensional Stacks Initial Grouping State section.
[MPR] Displays MPR stacks in Acquisition Plane View

PatientPlaneView = 0 when entering MPR mode.
;0 - default value Supported values:
ObliqueMainView = 1  0: Oblique Main View (Acquisition View)

(Default)
;1 - default value  1: Patient Plane View
For more information, refer to the Switching MPR
Plane Views section.
[KEY IMAGES] Sets the key images to 1024 pixels.
Width = 1024
Height = 1024
Page | 159
Index
Add Key ..................................................................................................................................................................................................... 111, 112

Angle ................................................................................................................................................................................................. 103, 104, 105
Angle between Lines ......................................................................................................................................................................................... 104
Arrow ........................................................................................................................................................................................................ 106, 107
Attachments .............................................................................................................................................................................................. 148, 149
Attachments List .............................................................................................................................................................................................. 149
AVI ............................................................................................................................................................................................................ 151, 152
Backward ............................................................................................................................................................................................................ 12
BMP/JPEG ................................................................................................................................................................................................. 153, 154
Calibrate ................................................................................................................................................................................................... 108, 109

Callout....................................................................................................................................................................................................... 105, 106
Default Measurement ...........................................................................................................................................................98, 99, 112, 126, 156

Delete ............................................................................................................................................................................................................... 149
Density ...................................................................................................................................................................................................... 101, 102
DiagNET ................................................................................................................................................................................................................ 9
Diagnostic Preferences ...................................................................................................................................... 15, 25, 40, 45, 47, 58, 66, 68, 156
DICOM .......................................................................................................................................................................................10, 43, 44, 92, 117
Dictation Started ................................................................................................................................................................................................ 21
Distance ...................................................... 100, 108, 119, 120, 124, 125, 126, 127, 128, 130, 131, 132, 134, 135, 145, 146, 151, 152, 153, 154
Edge Enhancement ............................................................................................................................................................................................. 60

ellipse................................................................................................................................................................................................................ 102
Ellipse ........................................................................................................................................................................................................ 102, 110
Enhancement .......................................................................................................................................................................................... 60, 61, 62
Erase ................................................................................................................................................................................................................. 110
Export ....................................................................................................................................................................................... 151, 152, 153, 154
File .................................................................................................................................................................................................................... 149

Final Report ........................................................................................................................................................................................................ 21
Fix....................................................................................................................................................................................................................... 15
Forward .............................................................................................................................................................................................................. 12
Hide .......................................................................................................................................................................................................... 109, 110
Page | 160
image 9, 32, 38, 42, 44, 47, 48, 49, 50, 51, 52, 54, 55, 56, 58, 59, 61, 62, 63, 65, 68, 69, 70, 71, 91, 93, 95, 98, 99, 111, 112, 113, 139, 142, 151,
153
Image ......................................................................................................................................................................... 38, 44, 46, 68, 111, 112, 158
Inverse .................................................................................................................................................................................................... 63, 64, 65
Link ......................................................................................................................................................................................................... 94, 95, 96

Lossy ........................................................................................................................................................................................38, 39, 40, 151, 153
Magnifier .......................................................................................................................................................................................... 57, 58, 59, 60

Main screen ......................................................................................................................................................... 98, 112, 115, 126, 152, 154, 156
Mark ....................................................................................................................................................................................................... 91, 92, 93
matrix ............................................................................................................................................................................................... 31, 32, 91, 93
Matrix ................................................................................................................................................................................................................. 31
Max ................................................................................................................................................................................................................... 110
MDC PACS Client ............................................................................................................................. 15, 25, 40, 45, 47, 58, 98, 115, 152, 154, 156
Measurements ..................................................................................................................................................................................................... 99
Palette Color ........................................................................................................................................................................................... 69, 71, 72

Pan ...............................................................................................................................................................................................53, 54, 55, 56, 57
Patient ................................................................................................................................................................................................................ 18
polygon ............................................................................................................................................................................................................. 102
Polygon ............................................................................................................................................................................................. 102, 103, 110
Preferences .............................................................................................. 15, 25, 40, 45, 47, 58, 66, 68, 70, 95, 98, 112, 115, 126, 152, 154, 156
Preliminary Report ............................................................................................................................................................................................. 21
Presentation State ......................................................................................................................................................................................... 37, 38
Print .......................................................................................................................................................................................................... 117, 120
Read.................................................................................................................................................................................................................... 21
rectangle ........................................................................................................................................................................................................... 102
Rectangle .......................................................................................................................................................................................... 102, 103, 110
Release All Marks................................................................................................................................................................................................ 91
Report ................................................................................................................................................................................................................. 21
Report Approved ................................................................................................................................................................................................ 21
Reset ................................................................................................................................................................................................................... 67
Rotate ................................................................................................................................................................................................................. 67
Sort ..................................................................................................................................................................................................................... 12
Stack ....................................................................................................................................................................................................... 24, 40, 41
Statistics............................................................................................................................................................................................................ 110
study ................................................................................................................................................................................................................... 20
Study Status ........................................................................................................................................................................................................ 19
SUV ................................................................................................................................................................................................................... 110
Page | 161
Text ................................................................................................................................................................................................... 105, 107, 108

Tools ............................................................................................................................................................ 15, 25, 40, 45, 47, 58, 66, 68, 95, 147
Unread ................................................................................................................................................................................................................ 20
Update ...................................................................................................................................................................................................... 149, 150
View ................................................................................................................................................................................................................. 149
Window Level ......................................................................................................................................................................................... 49, 50, 52
Zoom ...........................................................................................................................................................................................46, 47, 48, 49, 96
Page | 162

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14. Viewing Options ........................................................................................................................................... 37

19.8 Text Annotation (Text Choice) ................................................................................................................... 107

30. DiagNETBase.INI Configuration File Settings ........................................................................................... 158

WARNING: Check minimum requirements as specified in System Requirements section. "Unable

Minimum 2 GB RAM, recommended 4 GB

2.1 Advanced System Requirements

2.2 System Requirements for Stations Launching Images from a CD

 4522 170 21311 IntelliSpace PACS DCX R3.2 Instructions of Use

DICOM Digital Imaging and Communications in Medicine

6. Study Preview Panel

6.1 Collapse / Expand Studies

Figure 1: Collapse / Expand button – before clicking it

All the stacks

Figure 2: Collapse / Expand button – after clicking it

6.2 Sort Backward

Figure 3: Sort Backwards button

Top sort sorts the

Internal sort sorts the

Figure 4: Multi study example

6.3 Only Icons / Image information

Figure 5: Only icons / image information - before clicking it

Figure 6: Only icons / image information - after clicking it

7. Auto Hide mode

Figure 7: Fix pushpins

Figure 7 shows the Fix pushpin buttons in the DiagNET:

1 For Study Preview Panel

Figure 8: Setting Fix pushpin defaults

1 Relates to the Image toolbar

8. Image Selection Display

8.1 General Image Selection

8.2 Matrix Image Selection

Figure 9: Patient Navigation icons location

9.1 Patient Navigation in the Multi-Site Environment

10. Study Status Management

Figure 10: Study Status option

Study Scheduled (dependent on RIS)

Study Cancelled (dependent on RIS)

Open For Viewing

Trainee Dictation Started: This option indicates that an authorized trainee

Trainee Dictated: This option indicates that an authorized trainee has

Dictation Started: This option indicates that dictation by an authorized

Report Corrected: This option indicates that a corrected report is available

Report Verified: This option indicates that a verified report is available

11. Stack Navigation

11.1 Internal Stack Navigation

Figure 11: Stack Navigation icon location

Select the required multi-image/frame stack to start with

Click the button ( )

11.1.1 Image Navigation toolbar

Figure 12: Image toolbar navigation

1 To next – Move to next either frame or image

11.2 Stack Navigation Icons

Figure 13: Stack Navigation icons location

1 To first stack: Click this icon to reach the first stack

11.3 Navigating between Stack Images

11.3.1 Stack Navigation using Keyboard Shortcuts

Keyboard Shortcut Action

Keyboard Shortcut Action

The following table describes the stack navigation keyboard arrows

11.3.2 Navigating within and between Stacks Using the Mouse

11.3.3 Navigating between Studies